THE SAFETY AND EFFICACY OF THE USE OF METHOTREXATE IN LONG-TERM THERAPY FOR RHEUMATOID-ARTHRITIS
THE SAFETY AND EFFICACY OF THE USE OF METHOTREXATE IN LONG-TERM THERAPY FOR RHEUMATOID-ARTHRITIS
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DOI：
10.1002/art.1780290702
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发表时间：
1986-07-01
影响因子：
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通讯作者：
LEE, JK
中科院分区：
文献类型：
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作者：
KREMER, JM;LEE, JK
29例患者参加了一项口服甲氨蝶呤治疗难治性类风湿关节炎的安全性和有效性的前瞻性研究。患者接受的平均剂量为每周12.4 mg，平均持续时间为29.1个月。所有患者在基线、2年和此后每年进行肝活检。1个月后，患者的所有临床疗效指标均显著改善;最大改善往往发生在治疗约6个月后。X光片显示，11名接受测量的患者中有7名的侵蚀性疾病有所改善。平均泼尼松剂量显著减少。四名患者需要增加剂量的甲氨蝶呤延长治疗后，因为下降的临床反应。29例患者中有26例（90%）在某个时间观察到毒性，但调整剂量后，反应普遍变得轻微且可耐受。在60例连续肝活检中没有发现明显的肝毒性，尽管29例患者中有20例（70%）在某个时间观察到转氨酶水平升高。
Twenty-nine patients participated in a prospective study of the safety and efficacy of oral methotrexate in the treatment of refractory rheumatoid arthritis. Patients received a mean dosage of 12.4 mg weekly over a mean duration of 29.1 months. All patients had liver biopsies at baseline, 2 years, and annually thereafter. Patients improved significantly by all clinical measures of efficacy after 1 month; maximum improvement tended to occur after approximately 6 months of therapy. Radiographs showed improvement of erosive disease in 7 of 11 patients measured. There was a significant reduction in mean prednisone dosage. Four patients required an increase in the dosage of methotrexate after prolonged therapy, because of declining clinical response. Toxicity was noted at some time in 26 of 29 patients (90%), but reactions universally became mild and tolerable after adjustment of the dosage. No significant hepatotoxicity was found in 60 sequential liver biopsies, although elevated transaminase levels were noted at some time in 20 of 29 patients (70%).