Low-dose Methotrexate in the treatment of knee Osteoarthritis. Case report by Ergys Ramosaço in Journal of Clinical Case Reports Medical Images and Health Sciences

 Low-dose Methotrexate in the treatment of knee Osteoarthritis. Case report by Ergys Ramosaço in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Osteoarthritis (OA) is a degenerative disease, that affects all joints, but the knee joint is most often affected. Pain is the most disturbing sign for patients that forces them to seek medical care. There are in place many treatment strategies for knee osteoarthritis. The knee osteoarthritis treatment plan should be personalized for each patient. We present a patient, who has been diagnosed with knee OA. We use low-dose methotrexate in the treatment of knee osteoarthritis. After six months, the patient has an improvement in pain with 4 points (from 10 to 6). This case demonstrated that the use of methotrexate in knee osteoarthritis provided a clinically relevant reduction in knee pain and improvement in physical function

Keywords: Osteoarthritis, pain, treatment, methotrexate

Introduction

Osteoarthritis (OA) is a degenerative disease of the joint which is characterizes by fibrillation and erosion in cartilage, chondrocyte proliferation and osteophyte formation at the joint margins, and sclerosis of subchondral bone1.

Osteoarthritis affects all joints, but the knee joint is most often affected. Using data from the National Health Interview Survey, in the US, it is estimated that approximately 14 million people have symptomatic knee osteoarthritis2. Notably, more than half of those suffering from osteoarthritis are over 65 years of age.

According to the 2010 WHO Global Burden of Disease Study, the global prevalence of radiographically confirmed symptomatic knee OA in 2010 was estimated at 3.8% (CI95%: 3.6–4.1%)3 .

Pain is the most disturbing sign for patients that forces them to seek medical care. There are in place many treatment strategies for knee osteoarthritis.

The EULAR recommendations emphasize that the knee osteoarthritis treatment plan should be personalized for each patient, taking into account the patient's constitutional profile, their behaviors and knowledge, the co-morbidity and the treatment they receive, the influence and the presence of the risk factors, the degree of joint damage, what treatments are available and obviously, the costs of the treatment4.

Case report presentation

A 68-year-old patient, has been diagnosed with knee OA more than 15 years ago. The patient has been hypertensive for 17 years, and is treated with atenolol 50 mg per day, amlodipine 5 mg per day. The non-steroidal anti-inflammatory drugs, physiotherapy and hyaluronic acid intra-articular injection were used to alleviate knee pain. Initially she had periods of improvement, but the pain is evident, which seems to limit the patient's movements.  The patient performs clinical examinations, blood tests (blood cell counts, liver function, renal function, hepatitis B/C tests), and a knee MRI.

In these conditions, we set the treatment with methotrexate (six months treatment) starting with 7.5 mg per week for the first week. For the second week the dose was increased by 2.5 mg per week. We increase by 5 mg per week for the second 2 weeks and we used 15 mg per week for the remaining period.  A few days after taking methotrexate, the patient took folic acid tablets to reduce the methotrexate side effects. MTX is a folic acid antagonist which has both an anti-proliferative and an anti-inflammatory action5. We monitored the patient through biochemical analyses, and it turned out that the patient tolerated methotrexate quite well (ALT and AST normal). We also monitored the pain every two weeks for a period of 6 months and saw that the improvement in pain started to be felt 6 weeks after the start of the treatment. In the sixth month (week 24), the patient moved freely, she could easily flex the knee joint and, the knee pain is relieved pain assessed by visual analogue scale.

Discussion

Synovitis is highly prevalent in OA and is associated with pain6.

Methotrexate as the disease-modifying antirheumatic drug, is used for the treatment of AO of the knee by reducing local inflammatory cytokines, as well as inhibiting the infiltration of immune cells into OA joints. As a result, joint inflammation is controlled and joint pain is alleviated.

There is evidence that low-dose MTX may have beneficial effects in OA7,8. Methotrexate in the treatment of synovitis is a very good alternative because it is efficient, easy to administer and has a low cost.

Conclusion

This case demonstrated that the use of methotrexate in knee osteoarthritis provided a clinically relevant reduction in knee pain and improvement in physical function.

For more information: JCRMHS

Comments

Post a Comment

Popular posts from this blog

Fish bone: unusual cause of liver abscess by Haithem Zaafouri in Journal of Clinical Case Reports Medical Images and Health Sciences

  Fish bone: unusual cause of liver abscess by Haithem Zaafouri in Journal of Clinical Case Reports Medical Images and Health Sciences Description  A 41-year-old female admitted to our department of general surgery with a three days history of abdominal pain, fever and shivering. She was previously healthy without any past medical history. On examination, she was febrile at 39°C, and she had tenderness in the epigastric quadrant of the abdomen. Biological data showed leukocytosis at 22.10³ E/L, high C - reactive protein at 300mg/L, normal amylase and liver enzymesThe abdominal CT scan revealed a 5 cm left hepatic lobe abscess with hyperdense image into parenchyma which matches a 2 cm linear structure with calcium density. After ten days of intravenous antibiotics, an exploratory laparoscopy was done, and the foreign body was extracted etiopathogenic mechanism explains the left site of the hepatic abscess in these conditions. The extraction of the foreign body which can b...
Read more

Case Report about an Open Enucleation of the Talus by Drs. Bensaka Mohammed in Journal of Clinical Case Reports Medical Images and Health Sciences

 Case Report about an Open Enucleation of the Talus by Drs. Bensaka Mohammed in Journal of Clinical Case Reports Medical Images and Health Sciences Abstract  We report a case of open enucleation of the talus, surgically treated conservatively. Enucleation or triple dislocation of the talus is a rare and serious traumatic injury. The study reports case of a 55 years old, was the victim of an attack by a stone with a direct point of impact on the right ankle while the foot was fixed, resulting in total functional impotence and severe pain. Enucleation of the talus is a rare lesion, rarely described in the literature. The functional prognosis of the ankle is compromised by the risk of osteonecrosis. Introduction  Talus Enucleation or triple dislocation of the talus is a rare traumatic injury [1,2] accounting for 2- 10% of talar traumas [3,4]. A review of the literature revealed fewer than 80 cases of pure enucleation of the talus [5], and the majority were a consequence of...
Read more

New medication to treat speech delay by Ali Mohammadimoshganbar in Journal of Clinical Case Reports Medical Images and Health Sciences

  New medication to treat speech delay by Ali Mohammadimoshganbar in Journal of Clinical Case Reports Medical Images and Health Sciences Abstract  Background:  Delay in language development, social communication, play skills, and behavior in kids can be attributed to a variety of factors. One common cause is genetic predisposition[1], as children with a family history of language or developmental delays are more likely to experience similar challenges themselves. Additionally, neurological factors such as brain injury or abnormalities such as Seizures can impact a child's ability to develop language and social skills[2,3,4]. The most common and effective treatments available include speech therapy, social skills training, occupational therapy and play therapy, which help children improve their abilities. However, none of these treatments are definitive. Case presentation:  Here, we present a child who is currently 8 years old. At the age of three years and one mont...
Read more