Andersen P A, West S G, O'Dell J R, Via C S, Claypool R G, Kotzin B L
Ann Intern Med. 1985 Oct;103(4):489-96. doi: 10.7326/0003-4819-103-4-489.
Twelve patients with refractory rheumatoid arthritis were treated with weekly pulse methotrexate in a double-blind, placebo-controlled, crossover study. After 13 weeks of therapy, patients receiving methotrexate showed greater improvement, judged by degree of joint swelling and tenderness, duration of morning stiffness, and subjective assessments of clinical condition, compared to those receiving placebo (p less than or equal to 0.002). This improvement was associated with a decrease in sedimentation rate and decreases in levels of IgG, IgM, and IgA; no changes were seen in serum rheumatoid factor titer or complement protein levels. Proportions of mononuclear cell subsets that were abnormal before treatment (decreased percentage of total T cells, increased percentage of monocytes) improved toward normal after therapy with methotrexate. However, no changes were seen in elevated pretreatment Leu-3/Leu-2 ratios, in in-vitro proliferative responses of lymphocytes to mitogens, or in immunoglobulin secretory responses to pokeweed mitogen. Weekly pulse methotrexate is effective in the short-term treatment of refractory rheumatoid arthritis. Little evidence for cellular immune suppression was associated with this clinical benefit.
在一项双盲、安慰剂对照、交叉研究中，12例难治性类风湿关节炎患者接受了每周一次的甲氨蝶呤冲击治疗。治疗13周后，与接受安慰剂的患者相比，接受甲氨蝶呤治疗的患者在关节肿胀和压痛程度、晨僵持续时间以及临床状况主观评估方面显示出更大改善（p小于或等于0.002）。这种改善与血沉降低以及IgG、IgM和IgA水平降低相关；血清类风湿因子滴度或补体蛋白水平未见变化。治疗前异常的单核细胞亚群比例（总T细胞百分比降低、单核细胞百分比增加）在甲氨蝶呤治疗后趋向正常。然而，治疗前升高的Leu-3/Leu-2比值、淋巴细胞对有丝分裂原的体外增殖反应以及对商陆有丝分裂原的免疫球蛋白分泌反应均未见变化。每周一次的甲氨蝶呤冲击治疗在难治性类风湿关节炎的短期治疗中有效。几乎没有证据表明细胞免疫抑制与这种临床益处相关。
