Boerbooms A M, Kerstens P J, van Loenhout J W, Mulder J, van de Putte L B
Department of Rheumatology, University Hospital Nijmegen, The Netherlands.
Semin Arthritis Rheum. 1995 Jun;24(6):411-21. doi: 10.1016/s0049-0172(95)80009-3.
We studied the infection rate in patients with rheumatoid arthritis (RA) treated with low-dose methotrexate (MTX) in a 6-year open prospective study and in a 12-month randomized double blind trial comparing MTX with azathioprine (AZA) that was followed by a 3-year open prospective study. The literature on infections during low dose MTX in RA was reviewed. We also did a search for therapy-related opportunistic infections in RA and in MTX-treated psoriasis and psoriatic arthropathy patients. In our studies the infection rate during MTX treatment was higher in severe RA than in moderate RA. In severe RA there were often 2 infections simultaneously. The majority of the infections occurred in the first 1.5 years of treatment. There was no difference in the infection rate of MTX and AZA in the comparative trial. In the literature the infection rate was highest in short-term double-blind studies. Opportunistic infections are increasingly reported in RA treated with MTX and rarely with AZA, cyclosporine A, and cyclophosphamide or in MTX treated psoriasis and psoriatic arthropathy. In RA it appears that the initial period of treatment with MTX is the most vulnerable phase for infections, with the exception of opportunistic infections, which are not limited to a certain treatment period. Probably there are more MTX-associated infections in severe RA than in moderate RA.
我们在一项为期6年的开放性前瞻性研究中，以及在一项为期12个月的随机双盲试验（比较甲氨蝶呤与硫唑嘌呤）及随后为期3年的开放性前瞻性研究中，研究了接受低剂量甲氨蝶呤（MTX）治疗的类风湿关节炎（RA）患者的感染率。对关于RA患者低剂量MTX治疗期间感染情况的文献进行了综述。我们还搜索了RA患者以及MTX治疗的银屑病和银屑病关节炎患者中与治疗相关的机会性感染情况。在我们的研究中，MTX治疗期间重度RA患者的感染率高于中度RA患者。在重度RA患者中，常同时发生2次感染。大多数感染发生在治疗的前1.5年。在比较试验中，MTX和硫唑嘌呤的感染率没有差异。在文献中，短期双盲研究中的感染率最高。在接受MTX治疗的RA患者中越来越多地报告有机会性感染，而在接受硫唑嘌呤、环孢素A和环磷酰胺治疗的RA患者中或MTX治疗的银屑病和银屑病关节炎患者中则很少见。在RA中，似乎MTX治疗的初始阶段是感染最易发生的阶段，但机会性感染除外，机会性感染不限于特定的治疗时期。重度RA中可能比中度RA有更多与MTX相关的感染。
