Indirect Evidence for the Efficacy of Methotrexate in Diffuse Systemic Sclerosis

Excerpt

To the Editor:

The use of methotrexate (MTX) in the treatment of systemic sclerosis (SSc) remains controversial. We provide indirect evidence for the efficacy of MTX in 3 patients with diffuse SSc who had good response of skin scores to MTX, significant worsening after stopping MTX, and subsequent improvement with reinstitution of MTX.

Patients were 39 to 51 years old at reported onset of skin thickening. The initial modified Rodnan skin scores (mRSS) were all ≥ 20. All patients had Raynaud’s phenomenon and joint and gastrointestinal (GI) manifestations.

Patient 1 was positive for antinuclear antibody (ANA, speckled), but negative for ...