Ricci M, De Marco G, Desiati F, Mazzocchi D, Rotunno L, Battafarano N, Marchesoni A
U.O.C. Day Hospital di Reumatologia, Istituto Ortopedico Gaetano Pini, Milano, Italia.
Reumatismo. 2009 Apr-Jun;61(2):125-31. doi: 10.4081/reumatismo.2009.125.
The purpose of this study was to evaluate the long-term survival rate of Methotrexate (MTX) in the peripheral joint involvement of psoriatic arthritis (PsA) in a setting of everyday clinical practice.
This was an observational restrospective study performed using the data from a dermatological-rheumatological PsA clinic. All of the patients evaluated at this clinic from March 1997 to December 2007 who were started on MTX alone, had a three-year follow-up time or had discontinued the therapy were included into the survey.
Of the 174 evaluable patients, 104 (59.8%) were still taking MTX after three years of treatment. The reasons of therapy discontinuation in the remaining 70 (40.2%) patients were: 34 (19.5%) lost-to-follow-up, 18 (10.3%) adverse events, 14 (8%) inefficacies, and 4 (2.3%) deaths (none related to the therapy). MTX was effective in controlling joint inflammation but not in preventing their deterioration. Overall, adverse events were recorded in 43 patients (36.4% of the 114 patients with a three-year follow-up). No serious side effect occurred in the study population.
The results of this study showed that, in a setting of clinical pratice, MTX had a good three-year performance in patients with peripheral PsA. Almost 60% of them were still taking this drug at the end of the study period and the toxicity was more than acceptable. In our opinion, MTX might be considered the non-biological DMARD of choice for the treatment of this condition. However it should be used earlier and at higher doses.
本研究旨在评估在日常临床实践中，甲氨蝶呤（MTX）治疗银屑病关节炎（PsA）外周关节受累的长期生存率。
这是一项回顾性观察研究，使用来自皮肤科 - 风湿科PsA诊所的数据。纳入1997年3月至2007年12月在该诊所接受评估且单独开始使用MTX治疗、有三年随访时间或已停止治疗的所有患者。
在174例可评估患者中，104例（59.8%）在治疗三年后仍在服用MTX。其余70例（40.2%）患者停止治疗的原因如下：34例（19.5%）失访，18例（10.3%）出现不良事件，14例（8%）治疗无效，4例（2.3%）死亡（均与治疗无关）。MTX对控制关节炎症有效，但不能预防关节恶化。总体而言，43例患者（在114例有三年随访的患者中占36.4%）记录到不良事件。研究人群中未发生严重副作用。
本研究结果表明，在临床实践中，MTX对PsA外周关节受累患者有良好的三年治疗效果。接近60%的患者在研究期末仍在服用该药，且毒性在可接受范围内。我们认为，MTX可被视为治疗该病的首选非生物性改善病情抗风湿药。然而，应更早且更高剂量地使用该药。
