Safety of low dose methotrexate in elderly patients with rheumatoid arthritis
Safety of low dose methotrexate in elderly patients with rheumatoid arthritis
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DOI：
10.1136/pmj.76.902.787
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发表时间：
2000-12-01
影响因子：
5.1
通讯作者：
Rubinow, A
中科院分区：
文献类型：
--
作者：
Hirshberg, B;Muszkat, M;Rubinow, A
每周低剂量甲氨蝶呤是治疗类风湿性关节炎的既定方法，但其在老年人中的使用尚未得到充分研究。本研究的目的是评估其对老年类风湿关节炎患者的安全性。对在风湿科就诊的 65 岁以上类风湿性关节炎患者的临床记录进行了回顾性审查。符合条件的患者接受至少两年的随访，并接受甲氨蝶呤治疗，剂量为每周 7.5 毫克，同时维持同步治疗。对三十三名患者进行了研究。他们的平均年龄为 78.8 岁； 32 名女性，1 名男性。四名患者停止治疗，其中两名是因为血清肝酶升高，两名是因为胃肠道刺激。没有报告严重不良事件。两年后，血红蛋白水平从平均 (SD) 12.4 (1.3) g/dl 增加至 13.0 (1.1) g/dl（r = 0.226，p < 0.005）。白细胞计数从 7.9 (1.8) x 10(9)/1 显着降低至 6.8 (1.7) x 10(9)/1 (r = 0.184，p < 0.05)。没有观察到中性粒细胞减少症或粒细胞缺乏症的发作。血小板计数无显着下降。红细胞沉降率从 56.8 (30.8) 降低至 35.2 (24.6) mm/h (r 0.246，p < 0.01)。总之，老年患者低甲氨蝶呤治疗似乎是安全的。常规测定血清肝酶和肾功能可降低个体风险。
Weekly low dose methotrexate is an established treatment for rheumatoid arthritis, but its use in elderly people has not been adequately examined. The aim of this study was to evaluate its safety in elderly patients with rheumatoid arthritis. A retrospective review of the clinical records of rheumatoid arthritis patients over the age of 65 attending a rheumatology unit was conducted. Eligible patients were followed for at least two years and treated with methotrexate in a dose of 7.5 mg/week while being maintained on concurrent treatment. Thirty three patients were studied. Their mean age was 78.8 years; 32 were female and one was male. Treatment was discontinued in four patients, two because of raised serum liver enzymes and two because of gastrointestinal irritation. No serious adverse events were reported. After two years, haemoglobin levels increased from a mean (SD) of 12.4 (1.3) g/dl to 13.0 (1.1) g/dl (r = 0.226, p < 0.005). The white blood count was significantly reduced from 7.9 (1.8) x 10(9)/1 to 6.8 (1.7) x 10(9)/1 (r = 0.184, p < 0.05). No episodes of neutropenia or agranulocytosis were observed. There was a nonsignificant decrease in platelet count. The erythrocyte sedimentation rate decreased from 56.8 (30.8) to 35.2 (24.6) mm/h (r 0.246, p < 0.01). In conclusion, low methotrexate treatment in elderly patients appears to be safe. Routine determination of serum liver enzymes and renal function may reduce individual risk.