Biasi D, Carletto A, Caramaschi P, Bambara L M
Istituto di Patologia Medica, Università, Verona.
Recenti Prog Med. 1995 Dec;86(12):472-5.
Elderly onset rheumatoid arthritis is a not rare disease with relevant social implications. The most important question is represented by the therapeutic choice, in relation to the typical problems of the elderly patients and to the frequent coexistence of other diseases. In this work, we evaluated the practicability and the efficacy of methotrexate therapy, at the dose of 5 mg/week, in 27 patients affected by elderly onset rheumatoid arthritis (mean age 73.76 +/- 3.39 years, range 70-83). Low dose prednisone was associated in order to control painful symptoms. Also sulindac was allowed. Frequent clinical and hematochemical controls were made in order to precociously evaluate the appearance of side effects. All the 27 patients completed the first year of treatment; during this period there was no drop out. Sixteen patients finished the second year too; during this year one patient dropped out because of significant hypertransaminasemia and another patient did not respect the follow-up. Clinical and hematochemical parameters were monitored. A significant improvement of all data was observed from the third month. A further amelioration was recorded in the following months. Our data suggest the efficacy and the safety of low dose methotrexate in the treatment of elderly onset rheumatoid arthritis. A careful evaluation of side effects is obviously necessary.
老年发病的类风湿性关节炎是一种并不罕见且具有相关社会影响的疾病。最重要的问题体现在治疗选择上，这与老年患者的典型问题以及其他疾病的频繁共存有关。在这项研究中，我们评估了每周5毫克剂量甲氨蝶呤治疗27例老年发病类风湿性关节炎患者（平均年龄73.76±3.39岁，范围70 - 83岁）的实用性和疗效。联合使用低剂量泼尼松以控制疼痛症状，也允许使用舒林酸。进行频繁的临床和血液化学检查以便尽早评估副作用的出现。所有27例患者完成了第一年治疗；在此期间无退出病例。16例患者也完成了第二年治疗；在这一年中，1例患者因显著的转氨酶升高退出，另1例患者未遵守随访。监测临床和血液化学参数。从第三个月起观察到所有数据有显著改善，在随后几个月中进一步好转。我们的数据表明低剂量甲氨蝶呤治疗老年发病类风湿性关节炎有效且安全。显然，仔细评估副作用是必要的。
