van der Veen M J, van der Heide A, Kruize A A, Bijlsma J W
Department of Rheumatology, University Hospital Utrecht, The Netherlands.
Ann Rheum Dis. 1994 Apr;53(4):224-8. doi: 10.1136/ard.53.4.224.
To investigate prospectively the frequency and type of infections and the use of antibiotics among patients with rheumatoid arthritis (RA) on methotrexate (MTX) and patients with RA without MTX.
Every three months for one year 77 patients on MTX and 151 patients without MTX were asked about infections and the use of antibiotics by means of a standardised questionnaire. Medication was checked with the pharmacist.
In the MTX group there were significantly more infections and more antibiotic therapy. The relative risks for patients on MTX of infection or antibiotics use were 1.52 (95% Confidence Interval (CI) 1.04-2.22) and 1.49 (95% CI 1.04-2.13), respectively. The relative risk of MTX for respiratory tract infections was 1.43 (95% CI 0.96-2.14) and for skin infections 2.19 (95% CI 1.45-3.31). The increased risks could only partly be explained by differences in disease severity and were not related to either duration of MTX therapy or use of prednisone. Three patients in the MTX group had herpes zoster versus one in the control group.
Treatment with MTX increases the rate of infection and thus the use of antibiotics but does not lead to serious complications necessitating discontinuation of the drug.
前瞻性调查接受甲氨蝶呤（MTX）治疗的类风湿关节炎（RA）患者和未接受MTX治疗的RA患者的感染频率和类型以及抗生素的使用情况。
连续一年，每三个月通过标准化问卷询问77例接受MTX治疗的患者和151例未接受MTX治疗的患者有关感染和抗生素使用的情况。用药情况与药剂师核对。
MTX组的感染和抗生素治疗明显更多。接受MTX治疗的患者发生感染或使用抗生素的相对风险分别为1.52（95%置信区间（CI）1.04 - 2.22）和1.49（95%CI 1.04 - 2.13）。MTX导致呼吸道感染的相对风险为1.43（95%CI 0.96 - 2.14），导致皮肤感染的相对风险为2.19（95%CI 1.45 - 3.31）。风险增加只能部分由疾病严重程度的差异来解释，且与MTX治疗持续时间或泼尼松的使用均无关。MTX组有3例发生带状疱疹，而对照组有1例。
MTX治疗会增加感染率，从而增加抗生素的使用，但不会导致需要停药的严重并发症。
