Fiechtner J J, Miller D R, Starkebaum G
Department of Medicine, University of North Dakota, Fargo.
Arthritis Rheum. 1989 Feb;32(2):194-201. doi: 10.1002/anr.1780320212.
We evaluated the clinical and hematologic response to methotrexate (MTX) in 4 women with Felty's syndrome (FS) who had had neutropenia for 1-3 years. Since immune complexes or antineutrophil antibodies are implicated in the pathogenesis of the neutropenia of FS, we also measured both direct and indirect levels of neutrophil-reactive IgG. All 4 patients showed a prompt and dramatic increase in neutrophil counts within 1-2 months of starting MTX therapy. In 3 patients, the symptoms of arthritis also improved; in the fourth patient, arthritis worsened. Recurring infections ceased in 3 patients. Neutrophil-reactive IgG levels, which were elevated in all patients prior to treatment, decreased toward normal while the patients were receiving MTX therapy. We conclude that MTX is effective in treating the neutropenia of FS, in part by lowering neutrophil-reactive IgG.
我们评估了4名患有费尔蒂综合征（FS）且中性粒细胞减少已达1至3年的女性患者对甲氨蝶呤（MTX）的临床和血液学反应。由于免疫复合物或抗中性粒细胞抗体与FS中性粒细胞减少的发病机制有关，我们还检测了中性粒细胞反应性IgG的直接和间接水平。所有4例患者在开始MTX治疗后的1至2个月内中性粒细胞计数迅速且显著增加。3例患者的关节炎症状也有所改善；第4例患者的关节炎则加重。3例患者反复出现的感染停止。所有患者治疗前升高的中性粒细胞反应性IgG水平在接受MTX治疗期间降至正常。我们得出结论，MTX对治疗FS的中性粒细胞减少有效，部分原因是降低了中性粒细胞反应性IgG。
