Low dose pulse methotrexate therapy in rheumatoid arthritis.

Thirty-two patients with definite or classical rheumatoid arthritis were treated with low dose pulse methotrexate (MTX). A therapeutic response was shown in 2/3 of the patients by statistically significant joint changes and improved global response. Greater than one-half of those who improved demonstrated a drop in sedimentation rate. Eight patients discontinued treatment because of inefficacy and 2 because of gastrointestinal distress. One patient died of neoplasm. Five liver biopsies performed in patients with abnormal liver enzymes demonstrated no MTX related changes. We conclude that MTX may be an effective alternative to other more toxic immunosuppressive regimens and should undergo future evaluation.