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Matters arising
Low dose methotrexate osteopathy in a patient with polyarticular juvenile idiopathic arthritis
  1. M A Quinn1,
  2. M J Green1,
  3. A K S Gough1
  1. 1Harrogate District Hospital, UK
  1. Correspondence to:
    Dr A K S Gough, Harrogate, District Hospital;
    andrew.goughhhc-tr.northy.nhs.uk

https://doi.org/10.1136/ard.62.11.1123-a

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    We read with some surprise the article by Rudler and colleagues proposing a case of a 36 year old woman with methotrexate (MTX) osteopathy.1 The authors report insufficiency fractures after low dose MTX treatment for three months and further fractures two months later.

    They suggest that MTX osteopathy may be more common than expected in patients treated with low dose methotrexate, yet all the evidence suggests the opposite. MTX is now the most commonly prescribed disease modifying antirheumatic drug for rheumatoid arthritis in America and parts of Europe.2,3 We conservatively estimate that 120 000 patients receive low dose MTX in the UK alone, with historically a greater proportion of …

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