Use of methotrexate in patients with systemic lupus erythematosus and primary Sjögren's syndrome.

While there is still no convincing evidence that methotrexate is of benefit in primary Sjögren's syndrome, the SLE evidence on this rheumatology anchor drug is substantial. In fact, there are randomised controlled trials showing the benefit for methotrexate on overall SLE activity, reduction in glucocorticoid doses, and effects on lupus arthritis and lupus skin manifestations. In addition, methotrexate may be helpful in vasculitis, haematological manifestations, and perhaps kidney disease. Intrathecal methotrexate was successfully used in neuropsychiatric SLE. Taken together, using methotrexate in SLE is not only a common approach, but, at least in part, supported by evidence from clinical trials.