Cranney A B, McKendry R J, Wells G A, Ooi D S, Kanigsberg N D, Kraag G R, Smith C D
Division of Rheumatology, Ottawa Hospital, Ontario, Canada.
J Rheumatol. 2001 Nov;28(11):2395-9.
High dose methotrexate (MTX) has been linked with bone loss in oncology patients. However, it is unclear whether longterm low dose MTX used in the treatment of inflammatory arthritis is associated with bone loss. We compared the effect of low dose MTX on bone density in prospectively recruited patients with rheumatoid arthritis (RA) and psoriasis/psoriatic arthritis (Ps/PsA).
Thirty RA patients and 30 Ps/PsA patients taking MTX were compared to controls not taking MTX (30 with RA, 27 Ps/PsA). Bone mineral density (BMD) of the radius, lumbar spine, trochanter, and femoral neck was measured using Lunar dual energy x-ray absorptiometry. Student t tests were used to detect differences in bone density (using Z scores) of the MTX group versus controls for both the RA and Ps/PsA groups. Analysis of covariance was used to examine for confounders including disease duration, disease activity, age, and sex.
BMD of the radius/femoral neck/trochanter did not differ significantly between the MTX treated groups and controls when analyzed by Z scores. The mean difference between the MTX group and controls of the femoral neck was 0.040 (95% CI -0.40, 0.12) and 0.060 (95% CI -0.30, 0.15) for the RA and Ps/PsA groups, respectively. The absolute BMD of the lumbar spine (L2-L4) was higher in the RA MTX group than in controls. Analysis of covariance did not reveal an effect of study group on bone density.
This study suggests that low dose MTX does not have a negative effect on bone density, at either cortical or trabecular sites.
高剂量甲氨蝶呤（MTX）与肿瘤患者的骨质流失有关。然而，目前尚不清楚用于治疗炎性关节炎的长期低剂量MTX是否与骨质流失相关。我们比较了低剂量MTX对前瞻性招募的类风湿关节炎（RA）和银屑病/银屑病关节炎（Ps/PsA）患者骨密度的影响。
将30例服用MTX的RA患者和30例服用MTX的Ps/PsA患者与未服用MTX的对照组（30例RA患者、27例Ps/PsA患者）进行比较。使用Lunar双能X线吸收法测量桡骨、腰椎、大转子和股骨颈的骨矿物质密度（BMD）。采用学生t检验检测RA组和Ps/PsA组MTX组与对照组骨密度（使用Z评分）的差异。采用协方差分析来检验包括病程、疾病活动度、年龄和性别在内的混杂因素。
按Z评分分析时，MTX治疗组与对照组之间桡骨/股骨颈/大转子的BMD无显著差异。RA组和Ps/PsA组MTX组与对照组股骨颈的平均差异分别为0.040（95%CI -0.40，0.12）和0.060（95%CI -0.30，0.15）。RA MTX组腰椎（L2-L4）的绝对BMD高于对照组。协方差分析未显示研究组对骨密度有影响。
本研究表明，低剂量MTX对皮质骨或小梁骨部位的骨密度均无负面影响。
