Hilliquin P, Laoussadi S, Menkès C J
Service de Rhumatologie A, Hôpital Cochin, Paris.
Rev Rhum Mal Osteoartic. 1991 Jun;58(6):419-26.
This retrospective study involved 60 patients (7 men, 53 women) with rheumatoid arthritis (RA) and given methotrexate between 1985 and 1990. The mean time that RA had been present was 12 years and more than half of the patients had received more than 3 types of general treatment in the past. The mean total duration of MTX was 17.3 months, with a total dose of 790 mg. The efficacy of MTX was confirmed by a significant improvement in clinical and laboratory parameters. Treatment was withdrawn permanently in 21 cases (35% of patients). Adverse reactions, responsible for two thirds of treatment withdrawals (14/21) occurred in most instances during the first year of treatment. Hepatic toxicity was commonest. Two cases of aplasia were reported as well as 3 cases of pneumonitis, one fatal. These involved two cases of secondary infection and one of pneumonitis directly imputable to MTX. Withdrawals for inefficacy were rare, occurring in less than 10 p. cent of patients. Treatment continuation rates were 77 p. cent at 1 year, 66 p. cent at 18 months, 55 p. cent at 2 years, 42 p. cent at 3 years and 32 p. cent at 4 years. MTX is effective treatment for RA but is not free of adverse reactions, sometimes potentially fatal. Prolonged monitoring is necessary because of the sometimes delayed onset of adverse reactions.
这项回顾性研究纳入了60例类风湿关节炎（RA）患者（7例男性，53例女性），这些患者在1985年至1990年间接受了甲氨蝶呤治疗。RA的平均患病时间为12年，超过半数的患者过去接受过3种以上的常规治疗。甲氨蝶呤的平均总疗程为17.3个月，总剂量为790毫克。临床和实验室参数的显著改善证实了甲氨蝶呤的疗效。21例患者（占患者总数的35%）永久停药。不良反应导致了三分之二的停药情况（14/21），大多数不良反应发生在治疗的第一年。肝毒性最为常见。报告了2例再生障碍性贫血以及3例肺炎，其中1例死亡。这包括2例继发感染和1例直接归因于甲氨蝶呤的肺炎。因无效而停药的情况很少见，不到10%的患者出现这种情况。1年时的治疗持续率为77%，18个月时为66%，2年时为55%，3年时为42%，4年时为32%。甲氨蝶呤是治疗RA的有效药物，但并非没有不良反应，有时甚至可能致命。由于不良反应有时会延迟出现，因此需要进行长期监测。
