Wilson K, Abeles M
Department of Medicine, University of Connecticut Health Center, Farmington 06030-1310.
J Rheumatol. 1994 Sep;21(9):1674-7.
To investigate a possible role for methotrexate (MTX) in the treatment of patients with systemic lupus erythematosus (SLE) who require unacceptably high doses of glucocorticosteroids (GCS) for control of their disease.
Twelve patients with SLE participated in this open ended prospective study. Patients with active renal or central nervous system (CNS) disease were excluded as were patients with liver disease. Serological variables, SLE disease activity index, joint count, and prednisone dose were serially evaluated. Data were analyzed using paired t test and contingency table analysis.
Arthritis was the major persistent problem in 7 patients: 1 patient had recurrent pleuropericarditis, 2 patients had refractory cutaneous lupus rashes and 2 had vasculitis. Three patients discontinued MTX because of side effects. The remaining 9 patients have been treated from 7-26 months. In 6 patients the GCS dose was reduced by an average of 42%. In 1 patient symptoms subsided and joint count was reduced without change in the GCS dose. GCS dosage was increased in 2 patients: 1 with recurrent serositis, 1 with persistent vasculitis. No apparent effect on anti-dsDNA antibodies, complement or erythrocyte sedimentation rate (ESR) was noted.
MTX appears to be useful in selected patients with SLE, especially those with persistent synovitis.
探讨甲氨蝶呤（MTX）在治疗系统性红斑狼疮（SLE）患者中的可能作用，这些患者需要使用高剂量糖皮质激素（GCS）来控制病情，但目前的剂量难以接受。
12例SLE患者参与了这项开放性前瞻性研究。排除有活动性肾脏或中枢神经系统（CNS）疾病的患者以及患有肝脏疾病的患者。对血清学变量、SLE疾病活动指数、关节计数和泼尼松剂量进行连续评估。使用配对t检验和列联表分析对数据进行分析。
7例患者的主要持续性问题为关节炎；1例患者有复发性胸膜炎心包炎，2例患者有难治性皮肤狼疮皮疹，2例患者有血管炎。3例患者因副作用停用MTX。其余9例患者接受了7至26个月的治疗。6例患者的GCS剂量平均降低了42%。1例患者症状缓解且关节计数减少，GCS剂量未改变。2例患者的GCS剂量增加：1例有复发性浆膜炎，1例有持续性血管炎。未观察到对抗双链DNA抗体、补体或红细胞沉降率（ESR）有明显影响。
MTX似乎对部分SLE患者有用，尤其是那些有持续性滑膜炎的患者。
