Low incidence of hepatotoxicity associated with long-term, low-dose oral methotrexate in treatment of refractory psoriasis, psoriatic arthritis, and rheumatoid arthritis. An acceptable risk/benefit ratio.

Thirty patients with psoriasis or other nonmalignant diseases had liver biopsies done before treatment with low-dose methotrexate, 15 mg/week, and then at one- to two-year intervals as long as they continued the methotrexate. All patients were symptomatically improved on this regimen. The 15 patients who had normal liver biopsies at the start of the study had normal biopsies after methotrexate. Fifteen others had minor hepatic histologic abnormalities before treatment. Eleven patients had fatty infiltration. Ten showed no significant change after treatment while one had increased fat and portal fibrosis on a fourth liver biopsy done seven years after MTX was begun. This last patient, a former alcohol abuser, continued methotrexate and showed no further worsening at 8 years. The remaining four had portal fibrosis before treatment. One patient had less fibrosis after methotrexate, two patients slightly more fibrosis, and one a marked increase in portal fibrosis. No patient developed cirrhosis or clinical liver disease. Our results suggest that in the absence of alcohol consumption, low-dose weekly methotrexate treatment rarely causes clinically significant liver damage.

Six-month, double-blind comparison of sodium meclofenamate ("Meclomen') with buffered aspirin in the treatment of rheumatoid arthritis.

Sodium meclofenamate (200 to 400 mg daily) was compared with aspirin (2.4 to 4.8 g daily) for the treatment of rheumatoid arthritis in a 6-month, double-blind, multicentre study. Two groups of patients participated, one receiving stabilized doses of concomitant gold or steroid therapy and one not receiving such therapy. In these latter patients, sodium meclofenamate appeared to be more effective than aspirin; tenderness was reduced from 35% to 50% more on sodium meclofenamate throughout the study, the differences being statistically significant during the first 2 months, and over all condition improved in a significantly greater proportion of the patients receiving sodium meclofenamate. Among the patients receiving concomitant gold or steroid, neither drug appeared to be as effective as in the group not receiving the concomitant therapy and the results with both aspirin and sodium meclofenamate were virtually the same for all measures. With sodium meclofenamate the most common adverse reaction was diarrhoea; and with aspirin, it was tinnitus. The incidence of withdrawals for adverse reactions did not differ significantly between the two medication groups. Abnormal laboratory values were observed in a few patients, but the incidence did not differ between the groups. On the basis of the study, sodium meclofenamate appears to be relatively well tolerated and at least as effective as aspirin in the treatment of the symptoms of rheumatoid arthritis.

Inflammatory myopathy in oculopharyngeal dystrophy.

A 75-year-old French-Canadian woman with familial oculopharyngeal dystrophy demonstrated histopathologic alterations similar to those of idiopathic polymyositis. A second biopsy obtained 15 months later was more consistent with previously reported cases. It is suggested that certain patients with oculopharyngeal dystrophy may pass through an initial phase of secondary muscle inflammation similar to that seen in some other heritable myopathies.

Monoclonal IgM immunoglobulinemia in psoriatic arthritis.

Serum protein electrophoresis in a 61-year-old woman with psoriasis and psoriatic arthritis showed a monoclonal spike that was identified as IgM-kappa monoclonal immunoglobulinemia by immunodiffusion and immunoelectrophoresis. There was no clinical evidence of myeloma, Waldenström macroglobulinemia, or lymphoma, and the M component has not changed over a three-year observation period. This unusual occurrence may represent another disease entity that may be associated with nonmyelomatous monoclonal immunoglobulinemia.