Physical Activity in People with RA Starting Methotrexate Therapy

Sarfaroj Khan 


February 26, 2021


  • Majority of people with rheumatoid arthritis (RA) reported some physical activity (PA) when starting methotrexate (MTX); 28% of participants performed no PA when starting MTX.

  • 10% of those performing PA when starting MTX stopped over the first year.

  • Smoking, higher disability and greater socioeconomic deprivation were associated with stopping PA over the first year of MTX therapy.

Why this matters

  • Public health strategies aiming to maintain or promote PA in RA need to consider socio-economic barriers when designing and delivering interventions.

Study details

  • This analysis included 1468 people with early RA (median age, 60 years; 65.2% women) starting methotrexate treatment using data from the Rheumatoid Arthritis Medication Study (RAMS).

  • Funding: Medical Research Council, Versus Arthritis and the NIHR Manchester Biomedical Research Centre.

Key results

  • PA levels at baseline were:

    • no PA: 27.8%;

    • low PA (1-3 days/week): 35.3%; and

    • high PA (4-7 days/week): 36.9%.

  • 79.3% of participants maintained some PA or improved PA over the first 6 months of treatment (6 to 12 months: 80.7%).

  • 24.1% of participants reduced PA by 6 months, with 11.3% stopping PA completely (6 to 12 months: 22.6% and 10.2% respectively).

  • Higher disability (OR, 1.36; 95% CI, 1.02-1.80) and current smoking (OR, 1.47; 95% CI, 0.99-2.18) were associated with reduced PA, but the association with current smoking was not statistically significant.

  • Current smoking and higher disability were associated with stopping PA over the first year of MTX treatment (OR, 5.83; 95% CI, 1.98-17.20 and OR, 2.43; 95% CI, 1.20-4.91, respectively).

  • Greater socio-economic deprivation was associated with stopping PA (least vs most deprived: OR, 0.32; 95% CI, 0.09-1.11), but the association was not statistically significant.


  • PA was self-reported.


Gwinnutt JM, Alsafar H, Hyrich KL, Lunt M, Barton A, Mm Verstappen S; RAMS co-investigators. Do people with rheumatoid arthritis maintain their physical activity level at treatment onset over the first year of methotrexate therapy? Rheumatology (Oxford). 2021 Feb 19 [Epub ahead of print]. doi: 10.1093/rheumatology/keab060. PMID: 33605404.  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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