Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain.
J Clin Rheumatol. 2012 Aug;18(5):234-6. doi: 10.1097/RHU.0b013e3182611471.
Patients with calcium pyrophosphate deposition disease sometimes require a continuous therapy. Nonsteroidal anti-inflammatory drugs, colchicine, and glucocorticoids are commonly used with good results, but occasionally, these are ineffective, contraindicated, or not tolerated. We present our experience with methotrexate (MTX) in refractory CPP arthritis.
An observational study to describe and evaluate the use of MTX in refractory calcium pyrophosphate deposition disease was undertaken. Ten patients were included. Treatment response was evaluated by the physician (excellent, good, medium, poor, or absent response) and the patient as measured on a 10-cm visual analog scale (0 = no effect; 10 = complete resolution of symptoms). Adverse effects were recorded on all patients.
Five patients presented a persistent polyarthritis, 3 presented a persistent oligoarthritis, and 2 presented a very frequently recurring monoarthritis. Median MTX evaluation by patients on visual analog scale was 7.4, and physicians considered excellent (n = 2), good (n = 5), or medium (n = 3). The safety profile was generally good, but MTX was discontinued in 2 patients because of adverse effects (transient bone marrow aplasia and elevation of liver enzymes).
Methotrexate could be an effective and safe option for patients with refractory CPP arthritis, but additional studies are necessary to determine to what extent and for which patients MTX is effective.
患有焦磷酸钙沉积病的患者有时需要持续治疗。非甾体抗炎药、秋水仙碱和糖皮质激素通常疗效良好，但有时这些药物无效、禁忌或不能耐受。我们介绍了我们在难治性 CPP 关节炎中使用甲氨蝶呤（MTX）的经验。
进行了一项观察性研究，以描述和评估 MTX 在难治性焦磷酸钙沉积病中的应用。纳入了 10 名患者。治疗反应由医生（极好、好、中、差或无反应）和患者根据 10 厘米视觉模拟量表（0 = 无效果；10 = 症状完全缓解）进行评估。记录了所有患者的不良反应。
5 名患者表现为持续性多关节炎，3 名患者表现为持续性少关节炎，2 名患者表现为频繁复发的单关节炎。患者对 MTX 的中位数视觉模拟评分是 7.4，医生认为极好（n=2）、好（n=5）或中等（n=3）。安全性总体良好，但由于不良反应（短暂骨髓再生不良和肝酶升高），有 2 名患者停止使用 MTX。
甲氨蝶呤可能是治疗难治性 CPP 关节炎的有效且安全的选择，但需要进一步研究确定 MTX 在多大程度上以及对哪些患者有效。
