Kagawa University, Kagawa, Japan.
Arthritis Care Res (Hoboken). 2014 Sep;66(9):1302-9. doi: 10.1002/acr.22306.
Methotrexate (MTX) is used as an anchor drug for rheumatoid arthritis (RA). Lymphoproliferative disease (LPD) occasionally develops in patients treated with MTX, and is known as MTX-associated LPD (MTX-LPD). Although MTX-LPD occurs mainly in RA patients, it has not been established if MTX administration is an independent risk factor for LPD in RA patients. We examined the clinical characteristics of MTX-LPD in Japanese RA patients and attempted to determine the risk factors for MTX-LPD development.
We performed a nested case-control study on RA patients. We enrolled 5,753 RA patients from Kagawa, Japan. In age- and sex-matched patients, we separated patients who did not develop LPD under MTX treatment (MTX non-LPD group) from those that did (MTX-LPD group) and conducted a comparative examination. We used multivariate analysis to determine the independent risk factors for MTX-LPD onset.
There were 28 patients in the MTX-LPD group and 125 patients in the MTX non-LPD group. Multivariate analysis of the parameters extracted by univariate analysis revealed that the mean MTX dose was a risk factor for MTX-LPD after adjusting for age; therefore, higher MTX dose is associated with LPD onset in RA patients.
MTX is an independent risk factor for LPD onset in Japanese RA patients.
甲氨蝶呤（MTX）被用作类风湿关节炎（RA）的锚定药物。接受 MTX 治疗的患者偶尔会发展为淋巴增生性疾病（LPD），称为 MTX 相关 LPD（MTX-LPD）。尽管 MTX-LPD 主要发生在 RA 患者中，但 MTX 给药是否是 RA 患者 LPD 的独立危险因素尚未确定。我们检查了日本 RA 患者中 MTX-LPD 的临床特征，并试图确定 MTX-LPD 发展的危险因素。
我们对 RA 患者进行了嵌套病例对照研究。我们从日本香川县招募了 5753 名 RA 患者。在年龄和性别匹配的患者中，我们将未在 MTX 治疗下发生 LPD 的患者（MTX 非 LPD 组）与发生 LPD 的患者（MTX-LPD 组）分开，并进行了比较检查。我们使用多变量分析来确定 MTX-LPD 发病的独立危险因素。
MTX-LPD 组有 28 例患者，MTX 非 LPD 组有 125 例患者。对单变量分析提取的参数进行多变量分析显示，MTX 平均剂量是年龄调整后的 MTX-LPD 发病的危险因素；因此，较高的 MTX 剂量与 RA 患者的 LPD 发病有关。
MTX 是日本 RA 患者 LPD 发病的独立危险因素。
