From the Research
Intrarticular methotrexate is not recommended for people with shoulder pain due to lack of clinical utility, as shown in the most recent and highest quality study 1. The use of intrarticular methotrexate for shoulder pain has been explored in various studies, but the most recent and relevant study published in 2021 1 found that it does not have clinical utility for persistent monoarthritis in rheumatoid arthritis. This study, which evaluated six studies on intra-articular methotrexate, concluded that the addition of methotrexate to steroid intra-articular therapy was not beneficial, and singular methotrexate injection was not superior to control arms.
Some key points to consider when evaluating the use of intrarticular methotrexate for shoulder pain include:
- The typical dose of methotrexate used in intra-articular injections ranges from 10-25 mg, administered directly into the shoulder joint under sterile conditions.
- Treatment protocols often involve a single injection with assessment of response after 2-4 weeks, though some patients may receive a series of 3-4 injections spaced 1-2 weeks apart.
- Methotrexate works by inhibiting inflammatory processes within the joint, reducing synovial inflammation and subsequent pain.
- However, this treatment is not first-line for most shoulder pain and is more appropriate for specific inflammatory arthropathies rather than common conditions like rotator cuff tendinopathy or osteoarthritis.
- Potential side effects include post-injection flare, infection risk, and local tissue irritation.
It is essential to note that the use of intrarticular methotrexate should be approached with caution, and patients should undergo proper diagnostic evaluation, including imaging, to confirm the underlying cause of shoulder pain. Appropriate patient selection is crucial for successful outcomes, and alternative treatments, such as intra-articular steroids or tumor necrosis factor inhibitors, may be more effective for certain patients 1.