Internistisch-rheumatologische Gemeinschaftspraxis, Hamburg, Germany.
Clin Exp Rheumatol. 2010 Sep-Oct;28(5 Suppl 61):S178-82. Epub 2010 Oct 28.
Since the introduction of combined immunosuppressive therapy consisting of oral cyclophosphamide (CYC) and glucocorticosteroids (GC) in the 1970s, the outcome of antineutrophil cystoplasmic antibodies (ANCA)-associated vasculitides has improved dramatically over the last decades. However, the long-term follow-up of patients treated with CYC plus GC has revealed a high treatment-related morbidity and mortality and a high proportion of patients suffering from relapses (up to 50%), requiring CYC and GC again. Methotrexate (MTX) can replace CYC for induction of remission in patients with a non life-threatening disease course of ANCA associated vasculitides ('early systemic'). Furthermore, MTX can be used as a maintenance medication after induction of remission with CYC (plus GC), provided there is a decent renal function with a GFR >50 ml /min. As with any maintenance regimen, we do not know exactly for how long to continue MTX maintenance therapy. When using MTX as remission induction or maintenance regimen a tight control of urinary sediment and kidney function is mandatory in order to detect a potential renal relapse or de novo manifestation.
自 20 世纪 70 年代引入包含口服环磷酰胺（CYC）和糖皮质激素（GC）的联合免疫抑制疗法以来，抗中性粒细胞胞浆抗体（ANCA）相关性血管炎的治疗效果在过去几十年中得到了显著改善。然而，对接受 CYC+GC 治疗的患者进行长期随访后发现，该治疗方案相关的发病率和死亡率较高，且相当一部分患者会复发（高达 50%），需要再次使用 CYC 和 GC。甲氨蝶呤（MTX）可替代 CYC 用于诱导非危及生命的 ANCA 相关性血管炎（“早期全身性”）患者的缓解。此外，若患者的肾小球滤过率（GFR）>50ml/min，且肾功能尚可，则可在 CYC（联合 GC）诱导缓解后使用 MTX 作为维持治疗药物。与任何维持治疗方案一样，我们并不知道确切的 MTX 维持治疗应持续多长时间。在使用 MTX 诱导缓解或维持缓解时，为了检测潜在的肾脏复发或新发病变，必须严格控制尿沉渣和肾功能。
