Sandoval D M, Alarcón G S, Morgan S L
Department of Medicine, University of Alabama at Birmingham, USA.
Br J Rheumatol. 1995 Nov;34 Suppl 2:49-56.
Methotrexate (MTX) is an antifolate that has been in use for the treatment of rheumatoid arthritis (RA) since the early 1980s. Its efficacy has been clearly documented [1-4] and its administration early in the course of the disease is now generally accepted [5]. Side-effects from low weekly pulse MTX have been reported [1-6] and it was our initial experience that toxicity, rather than lack of efficacy, was the major factor limiting its clinical use [7]. However, when compared with other disease-modifying antirheumatic drugs, its toxicity appears to be comparable to that of antimalarials [8, 9]. The purpose of this paper is to discuss the possible mechanisms responsible for toxicity due to MTX used at low weekly pulse doses for the treatment of RA, as well as the different toxic manifestations reported in the literature.
甲氨蝶呤（MTX）是一种抗叶酸药物，自20世纪80年代初以来一直用于治疗类风湿关节炎（RA）。其疗效已有明确记载[1-4]，目前普遍认为应在疾病早期使用[5]。已有报道称低剂量每周脉冲式使用MTX会产生副作用[1-6]，我们最初的经验是，毒性而非疗效不佳是限制其临床应用的主要因素[7]。然而，与其他改善病情的抗风湿药物相比，其毒性似乎与抗疟药相当[8,9]。本文旨在探讨低剂量每周脉冲式使用MTX治疗RA时可能导致毒性的机制，以及文献中报道的不同毒性表现。
