O'Dell J
Department of Internal Medicine, Section of Rheumatology and Immunology, University of Nebraska Medical Center, 983025 Nebraska Medical Center, Omaha, NE 68198-3025, USA.
J Rheumatol Suppl. 2001 Jun;62:21-6.
Methotrexate (MTX) is one of the disease modifying antirheumatic drugs (DMARD) commonly used to treat rheumatoid arthritis (RA). However, MTX therapy alone rarely results in remission and frequently does not even produce 50% improvement. Therefore, over the course of their disease, many patients will require additional therapy to manage their clinical symptoms. A number of treatment options have proven effective for such patients, most of which entail the continuation of MTX therapy and the addition of other DMARD. Although the combination of MTX and hydroxychloroquine (HCQ) is the one most commonly used in the US, many clinicians (particularly in Europe) prefer the combination of MTX and sulfasalazine. In addition, excellent data now exist for the triple combination of MTX, HCQ, and sulfasalazine in patients who have had a suboptimal response to MTX, as well as in those with early or well established disease. Other combinations, including MTX + cyclosporine or leflunomide, have also been helpful in some patients. Most recently, the tumor necrosis factor blockers, etanercept and infliximab, have successfully been used to treat a number of patients resistant to MTX. The combination of MTX with DMARD or biological agents with different mechanisms of action greatly expands the treatment options for patients with RA.
甲氨蝶呤（MTX）是常用于治疗类风湿关节炎（RA）的改善病情抗风湿药（DMARD）之一。然而，单独使用MTX治疗很少能导致病情缓解，甚至常常无法产生50%的改善效果。因此，在疾病过程中，许多患者需要额外的治疗来控制临床症状。已证实多种治疗方案对这类患者有效，其中大多数需要继续MTX治疗并加用其他DMARD。虽然MTX与羟氯喹（HCQ）联合是美国最常用的方案，但许多临床医生（尤其是在欧洲）更倾向于MTX与柳氮磺胺吡啶联合。此外，对于对MTX反应欠佳的患者以及早期或病情已确诊的患者，MTX、HCQ和柳氮磺胺吡啶三联联合治疗也有出色的数据支持。其他联合方案，包括MTX + 环孢素或来氟米特，对一些患者也有帮助。最近，肿瘤坏死因子阻滞剂依那西普和英夫利昔单抗已成功用于治疗一些对MTX耐药的患者。MTX与DMARD或具有不同作用机制的生物制剂联合，极大地扩展了RA患者的治疗选择。
