Furst D E
Department of Medicine, University of Medicine and Dentistry, New Brunswick, NJ 08903.
Semin Arthritis Rheum. 1990 Oct;20(2):69-75. doi: 10.1016/0049-0172(90)90019-c.
Although methotrexate (MTX) is an effective antirheumatic drug, it cannot clearly be defined as a disease modifying antirheumatic drug (DMARD), when this term is characterized by its effect on radiographs or laboratory data. Current data, in the form of small studies or case reports, show that MTX's hepatic toxicity is not yet fully defined, that its acute pulmonary toxicity is significant, that systemic fungal infections may be associated with MTX use in rheumatoid arthritis (RA), that unexplained significant weight loss can be a problem, and that the consequence of drug interactions with MTX are not yet fully known. Thus, although clearly an effective antiinflammatory drug in RA, the place of MTX in the RA armamentarium is not fully defined. For this reason, MTX should not at present be used as the first second-line agent in RA after nonsteroidal antiinflammatory drugs (NSAIDs) fail.
尽管甲氨蝶呤（MTX）是一种有效的抗风湿药物，但当“改善病情抗风湿药物”（DMARD）这一术语以其对X光片或实验室数据的影响来定义时，MTX并不能明确被归类为改善病情抗风湿药物。目前以小型研究或病例报告形式呈现的数据表明，MTX的肝毒性尚未完全明确，其急性肺毒性较为显著，系统性真菌感染可能与类风湿关节炎（RA）患者使用MTX有关，不明原因的显著体重减轻可能是个问题，并且MTX与其他药物相互作用的后果也尚未完全清楚。因此，尽管MTX在RA中显然是一种有效的抗炎药物，但其在RA治疗药物中的地位尚未完全明确。出于这个原因，目前在非甾体抗炎药（NSAIDs）治疗失败后，MTX不应作为RA的首选二线药物。
