Segal R, Caspi D, Tishler M, Fishel B, Yaron M
Department of Rheumatology, Ichilov Hospital, Tel Aviv University, Sackler Faculty of Medicine, Israel.
Arthritis Rheum. 1988 Sep;31(9):1182-5. doi: 10.1002/art.1780310915.
Three women with classic rheumatoid arthritis, who were receiving weekly doses of methotrexate (MTX), developed accelerated subcutaneous nodulosis, despite good response to the drug. In 2 of the patients, the onset of nodulosis occurred within 3 months and 5 months, respectively, after starting MTX; in the third patient, it was observed only after 4 years of MTX therapy. In all 3 patients, the onset was unusually abrupt, with extensive distribution and remarkable nodule size. Additional manifestations of cutaneous vasculitis in 2 of the patients and Raynaud's phenomenon in the third appeared concomitantly with the nodulosis. Physicians prescribing MTX therapy for patients with rheumatoid arthritis should be aware of these potential complications.
三名患有典型类风湿性关节炎且每周接受甲氨蝶呤（MTX）治疗的女性，尽管对该药物反应良好，但仍出现了皮下结节病加速发展的情况。其中两名患者在开始使用MTX后分别于3个月和5个月内出现结节病；第三名患者在MTX治疗4年后才观察到结节病。在所有三名患者中，发病异常突然，分布广泛且结节尺寸显著。其中两名患者出现皮肤血管炎的其他表现，第三名患者出现雷诺现象，这些均与结节病同时出现。为类风湿性关节炎患者开MTX治疗处方的医生应意识到这些潜在并发症。
