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Postgraduate Medical Journal 2000;76:787-789; doi:10.1136/pmj.76.902.787
© 2000 BMJ Publishing Group Ltd and The Fellowship of Postgraduate Medicine.
Postgrad Med J 2000;76:787-789 ( December )

Safety of low dose methotrexate in elderly patients with rheumatoid arthritis

Boaz Hirshberga, Mordechi Muszkatb, Ora Schlesingerc, Alan Rubinowc

a Department of Internal Medicine, Hadassah University Hospital, PO Box 12000, Jerusalem 91120, Israel, b Department of Clinical Pharmacology, Hadassah University Hospital, c Rheumatology Unit, Hadassah University Hospital

Correspondence to: Dr Rubinow rubinov{at}cc.huji.ac.il

Submitted 20 December 1999; Accepted 9 May 2000

Weekly low dose methotrexate is an established treatment for rheumatoid arthritis, but its use in elderly people has not been adequately examined. The aim of this study was to evaluate its safety in elderly patients with rheumatoid arthritis. A retrospective review of the clinical records of rheumatoid arthritis patients over the age of 65 attending a rheumatology unit was conducted. Eligible patients were followed for at least two years and treated with methotrexate in a dose of 7.5 mg/week while being maintained on concurrent treatment. Thirty three patients were studied. Their mean age was 78.8 years; 32 were female and one was male. Treatment was discontinued in four patients, two because of raised serum liver enzymes and two because of gastrointestinal irritation. No serious adverse events were reported. After two years, haemoglobin levels increased from a mean (SD) of 12.4 (1.3) g/dl to 13.0 (1.1) g/dl (r = 0.226, p < 0.005). The white blood count was significantly reduced from 7.9 (1.8) × 109/l to 6.8 (1.7) × 109/l (r = 0.184, p < 0.05). No episodes of neutropenia or agranulocytosis were observed. There was a non-significant decrease in platelet count. The erythrocyte sedimentation rate decreased from 56.8 (30.8) to 35.2 (24.6) mm/h (r = 0.246, p < 0.01). In conclusion, low methotrexate treatment in elderly patients appears to be safe. Routine determination of serum liver enzymes and renal function may reduce individual risk.


Keywords: methotrexate; elderly; safety

© 2000 by The Fellowship of Postgraduate Medicine
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