From the Guidelines
Intrarticular methotrexate is not recommended for treating shoulder osteoarthritis due to the lack of evidence supporting its effectiveness in this condition. The most recent and highest quality study, 1, which is the 2019 American College of Rheumatology guideline for the management of osteoarthritis, strongly recommends against the use of methotrexate in patients with knee, hip, and/or hand osteoarthritis (OA) due to its demonstrated lack of efficacy. Although this guideline does not specifically address shoulder osteoarthritis, the underlying pathophysiology of OA is similar across different joints, involving degenerative changes rather than the autoimmune inflammation that methotrexate targets.
Key points to consider in the management of shoulder osteoarthritis include:
- The use of oral anti-inflammatory medications (NSAIDs like ibuprofen or naproxen) for pain management
- Physical therapy and activity modification to improve joint function and reduce pain
- Intrarticular corticosteroid injections for temporary pain relief
- Hyaluronic acid injections may provide some benefit through viscosupplementation, although the evidence is not strong
- In advanced cases, surgical options like shoulder arthroplasty might be considered
The evidence from studies on methotrexate in other conditions, such as ankylosing spondylitis 1, also does not support its use in osteoarthritis, showing no significant improvement in disease activity or function with methotrexate treatment. Furthermore, methotrexate treatment is associated with potential side effects, including nausea and hepatic abnormalities 1. Therefore, based on the current evidence, intrarticular methotrexate should not be used as a treatment for shoulder osteoarthritis, and other established treatments should be prioritized to improve patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Intra-Articular Methotrexate for Shoulder Osteoarthritis
- There is limited evidence on the use of intra-articular methotrexate for shoulder osteoarthritis, as most studies focus on knee osteoarthritis or rheumatoid arthritis 2.
- A study on rheumatoid arthritis found that intra-articular methotrexate was not beneficial when added to steroid intra-articular therapy, and singular methotrexate injection was not superior to control arms 2.
- The available evidence on shoulder osteoarthritis suggests that conservative treatment options include physical therapy, pharmacological therapy, and biological therapy, but does not mention intra-articular methotrexate as a treatment option 3, 4, 5.
- Intra-articular injections, such as corticosteroids and hyaluronic acid, are mentioned as treatment options for shoulder osteoarthritis, but methotrexate is not specifically mentioned 3, 4, 5.
Alternative Treatment Options
- Physical therapy is a recommended treatment option for shoulder osteoarthritis, aiming to decrease pain, increase shoulder range of motion, and protect the glenohumeral joint 3.
- Pharmacological therapy, such as non-steroidal anti-inflammatory drugs, is also recommended to reduce pain and inflammation in the joint 3, 4.
- Biological therapy, including platelet-rich plasma and mesenchymal stem cells, has shown promise in reducing shoulder pain, but more evidence is needed to determine their effectiveness 3.