Low-dose methotrexate: an effective corticosteroid-sparing agent in the musculoskeletal manifestations of sarcoidosis

Extrapulmonary sarcoidosis, and particularly the presence of musculoskeletal
complications of the disease, may require chronic corticosteroid therapy. In five
patients with biopsy-proven sarcoidosis and presenting recalcitrant forms of the
disease, we introduced low-dose oral methotrexate (MTX) [10 mg/week (7.5-15)] for
30 months (16-34) to control the clinical and biological symptoms as well as to
try to reduce the intolerated steroid posology. Beneficial effects were observed
within 8-12 weeks in all patients, which allowed a reduction of 59% (35-75) of
the corticosteroid posology, and maintained with a follow-up of 3 yr in 4/5
patients. No significant toxicity was observed. MTX appears to be an efficient,
safe and corticosteroid-sparing therapeutic agent for the treatment of
recalcitrant musculoskeletal manifestations of sarcoidosis.