Okay, I'm no expert but I am a researcher by training and I've been trying to educate myself on the AS research and just wanted to jump in about MTX having no role in the tx of AS since I've seen this elsewhere.

In their 2015 paper ( American College of Rheumatology ) they say "In adults with active AS despite treatment with NSAIDs, we conditionally recommend against treatment with SAARDs..." and then they cite the lack of evidence for its effectiveness (i.e., we don't have enough good research to say that it works) but also the lack of quality research (i.e., we don't have enough good research to assess whether it works).

On the AS fact page on their website ( Spondyloarthritis - American College of Rheumatology ), they say "For patients who do not respond to the above lines of treatment, disease modifying antirheumatic drugs (commonly called DMARDs) such as sulfasalazine (Azulfidine) might be effective."

There are two relatively recent Cochrane reviews on AS and MTX (Methotrexate for ankylosing spondylitis. ) and SSZ ( Sulfasalazine for ankylosing spondylitis. ). Regarding MTX they say, "There is not enough evidence to support any benefit of MTX in the treatment of AS. High-quality RCTs of larger sample sizes are needed to clarify the effect(s) of MTX on AS." For SSZ, their conclusion is more equivocal but similar, "There is not enough evidence to support any benefit of sulfasalazine... in the treatment of AS. Further studies, with larger sample sizes, longer duration, and using validated outcome measures are needed to verify the uncertainty of sulfasalazine in AS."

I'm not disagreeing with the earlier comment but I just had to point out that there's a big difference btwn "there's good evidence to show it does not work," and "there's no good evidence to show if it does or does not work."



There's a recognition of the role of DMARDs with AS but that it's different than with RA: "The term 'DMARD' has been borrowed from rheumatoid arthritis, and none of the DMARDs have been shown to prevent or significantly decrease the rate of progression of structural damage which is required to be qualified as a disease-controlling antirheumatic drug for AS." (from Best Pract Res Clin Rheumatol. )

Others have noted the evidence that DMARDs reduce the frequency with which biologics are rejected by the body ( Ann Rheum Dis. 2013 ). So even if a DMARD might not be disease modifying for AS, "An important question is whether MTX should be prescribed in combination with biologic therapy in patients with AS, where DMARDs are not routinely prescribed for axial disease... Concomitant use of MTX may improve drug survival, reduce immunogenicity and prevent secondary inefficacy, which is of particular significance in AS and psoriasis, where, compared with RA, there are fewer classes of biologics to switch to in the event of treatment failure." ( Rheumatology (Oxford) (2014) )

So, it's complicated. I don't know if any of that helps with the original question and I've probably just made myself look like a crazy person by nerding out on all that research so I'm going to go back into lurking mode...

**slowly backs away from computer**


Edited by Ucla08 (04/19/17 07:11 PM)