Evaluating the efficacy of methotrexate in pain severity reduction and improvement of quality of life in patients with moderate to severe knee osteoarthritis

Background & Objectives: Knee osteoarthritis (OA) is common findings with age increases which causes low quality of life due to pain and limitation in daily activity. No proper pharmacologic therapy have been recommended for pain control in these patients,; however, recent studies indicated that methotrexate due to anti-inflammatory effects could reduce pain. In this study we aimed to evaluate the efficacy of methotrexate in pain control and improvement of quality of life in patients with moderate to severe knee OA. Methods: In this randomized clinical trial, 100 patients with moderate to severe knee OA were allocated to receive methotrexate (n=50) 7.5 mg and increase to 15 mg weekly after first months or placebo (n=50) for six months. Pain severity was measured using visual analogue scale (VAS), functional status was with Western Ontario and McMaster Universities Arthritis Index (WOMAC) and quality of life with SF-12 questionnaire before and 3 and 6 months after intervention and results were compared between groups. Results: Methotrexate group compared to placebo in the months 3 and 6th after intervention had significant improvement in VAS, WOMAC total score, pain and physical function subscales and SF-12. The need for NSAIDS was slightly higher in placebo group with no significant difference (20% vs. 36%, p=0.07). Complications regarding methotrexate use was observed in no cases. Conclusion: Treatment with methotrexate in patients with moderate to severe knee OA could reduce pain severity and improve functional status and quality of life in these patients