Bachta Artur, Kisiel Bartłomiej, Tłustochowicz Mateusz, Raczkiewicz Anna, Rękas Marek, Tłustochowicz Witold
Department of Internal Diseases and Rheumatology, Military Institute of Medicine, Warsaw, Poland.
Department of Ophthalmology, Military Institute of Medicine, Warsaw, Poland.
Arch Immunol Ther Exp (Warsz). 2017 Feb;65(1):93-97. doi: 10.1007/s00005-016-0402-1. Epub 2016 May 11.
To evaluate prospectively the efficacy of methotrexate (MTX) in the treatment of recurrent idiopathic acute anterior uveitis (RIAAU). Nineteen out of 22 RIAAU patients completed the study (two patients withdrew their consent shortly after study initiation, one patient discontinued after 4 weeks because of the adverse effects). All patients were treated with MTX in a starting dose of 15 mg/week, increased to target dose of 25 mg/week after 4 weeks. In patients taking systemic corticosteroids (CS) the dose was gradually tapered (by 2.5 mg every week) until discontinuation. The mean follow-up period was 3.3 years (19-59 months). Sixteen patients (84 %) remained flare-free on MTX therapy. In the remaining three patients the mean interval between flares increased from 4.8 to 18.3 months. Systemic CS were tapered off in all patients. The number of acute anterior uveitis flares in the whole cohort decreased from 2.12 to 0.11/patient-year (p < 0.0001). All flares observed on MTX therapy occurred in HLA-B27-positive patients. MTX dosed at 25 mg/week is highly effective in the treatment of RIAAU.
前瞻性评估甲氨蝶呤（MTX）治疗复发性特发性急性前葡萄膜炎（RIAAU）的疗效。22例RIAAU患者中有19例完成了研究（2例患者在研究开始后不久撤回同意，1例患者在4周后因不良反应停药）。所有患者均接受MTX治疗，起始剂量为15mg/周，4周后增至目标剂量25mg/周。正在服用全身用糖皮质激素（CS）的患者，剂量逐渐递减（每周减2.5mg）直至停用。平均随访期为3.3年（19 - 59个月）。16例患者（84%）在MTX治疗期间未出现病情复发。其余3例患者复发间隔时间从平均4.8个月增至18.3个月。所有患者的全身用CS均已停用。整个队列中急性前葡萄膜炎的发作次数从2.12次/患者年降至0.11次/患者年（p < 0.0001）。MTX治疗期间观察到的所有复发均发生在HLA - B27阳性患者中。每周服用25mg的MTX治疗RIAAU疗效显著。
