Department of Clinical Immunology and Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, India.
Rheumatology (Oxford). 2019 May 1;58(5):869-873. doi: 10.1093/rheumatology/key369.
Despite the widespread clinical use of MTX in PsA, data from published randomized controlled studies suggest limited efficacy. The objective of the present study was to document the efficacy of MTX.
This was an open-label, prospective study of patients satisfying the ClASsification criteria for Psoriatic ARthritis study (CASPAR) criteria for PsA who received MTX in doses of ⩾15 mg/week throughout the follow-up period of 9 months. Disease activity was assessed across various domains by tender and swollen joint count, physician and patient global assessment, DAS-28 ESR, Clinical Disease Activity Index for PsA (cDAPSA), Leeds Dactylitis Instrument basic, Leeds Enthesitis Index (LEI), Psoriasis Area and Severity Index (PASI), Minimal Disease Activity and HAQ (CRD Pune version) at baseline and at 3, 6 and 9 months of follow-up. Response to therapy was assessed by EULAR DAS28 ESR, Disease Activity Index for PsA (cDAPSA) response, HAQ response and PASI75. MTX dose escalation and the use of combination DMARDS were dictated by disease activity.
A total of 73 patients were included, with mean (s.d.) age 44 (9.7) years. The mean (s.d.) dose of MTX used was 17.5 (3.8) mg/week. Seven patients received additional DMARDS (LEF/SSZ). At the end of 9 months, significant improvement (P < 0.05) was noted in the tender joint count, swollen joint count, global activity, DAS-28ESR, cDAPSA, Leeds Dactylitis Index basic, LEI, PASI and HAQ. Major cDAPSA response was achieved in 58.9% of patients. EULAR DAS28 moderate and good response was achieved in 74% and 6.8% of patients, respectively. Minimal Disease Activity was achieved in 63% of patients. A PASI75 response and HAQ response was achieved in 67.9% and 65.8% of patients, respectively.
MTX initiated at ⩾15 mg/week with targeted escalation resulted in significant improvement in the skin, joint, dactylitis, enthesitis and functional domains of PsA.
尽管 MTX 在 PsA 中广泛应用于临床，但来自已发表的随机对照研究的数据表明其疗效有限。本研究的目的是记录 MTX 的疗效。
这是一项开放标签、前瞻性研究，纳入了符合关节炎研究的分类标准（CASPAR）标准的 PsA 患者，这些患者在 9 个月的随访期间接受了 ⩾15mg/周的 MTX 治疗。通过压痛关节和肿胀关节计数、医生和患者整体评估、DAS28 ESR、关节炎临床疾病活动指数（cDAPSA）、利兹关节炎指数（LEI）、银屑病面积和严重程度指数（PASI）、最小疾病活动度和健康评估问卷（CRD 浦那版本），评估疾病在各个领域的活动度，这些评估在基线和 3、6 和 9 个月的随访时进行。通过 EULAR DAS28 ESR、PsA 疾病活动指数（cDAPSA）应答、健康评估问卷应答和 PASI75 来评估治疗应答。根据疾病活动度决定 MTX 剂量增加和联合使用 DMARDs。
共纳入 73 例患者，平均（标准差）年龄为 44（9.7）岁。MTX 的平均（标准差）剂量为 17.5（3.8）mg/周。7 例患者接受了额外的 DMARDs（LEF/SSZ）。9 个月结束时，压痛关节计数、肿胀关节计数、整体活动度、DAS28 ESR、cDAPSA、利兹关节炎指数基本、LEI、PASI 和健康评估问卷均有显著改善（P<0.05）。58.9%的患者达到主要 cDAPSA 应答。74%和 6.8%的患者分别达到 EULAR DAS28 中度和良好应答。63%的患者达到最小疾病活动度。67.9%和 65.8%的患者分别达到 PASI75 应答和健康评估问卷应答。
起始剂量 ⩾15mg/周的 MTX 治疗，并进行目标剂量增加，可显著改善 PsA 的皮肤、关节、腊肠指、附着点炎和功能等方面。
