Bologna C, Jorgensen C, Sany J
Service d'Immuno-Rhumatologie, CHU Lapeyronie, Montpellier, France.
Clin Exp Rheumatol. 1996 Jul-Aug;14(4):401-6.
To investigate whether the association of methotrexate (MTX) and corticosteroids introduced concomitantly is more effective than MTX alone in patients with rheumatoid arthritis (RA).
Twenty-eight RA patients (group 1) were treated with MTX (mean dose: 10 +/- 1.4 mg/week) and corticosteroids (mean dose: 14.9 +/- 5.6 mg/day, range: 5-25) introduced concomitantly, and were compared to 251 RA patients (group 2) treated with MTX alone (mean dose: 9.8 +/-1.5 mg/week). Variations in the clinical (number of swollen and painful joints, morning stiffness, Ritchie's articular index), biological (ESR, CRP), and radiological parameters were studied. Remission was defined according to Pinals' criteria. At baseline, there were no significant differences between the two groups, except for a greater number of swollen and painful joints in group 1 (p = 0.03 and p = 0.01, respectively). The total MTX dose and the duration of treatment (26 +/- 21.8 months in group 1 versus 33.5 +/- 27.2) months in group 2) did not differ between the two groups.
We noted a more marked reduction in the number of swollen and the number of painful joints in group 1 (p = 0.03). No differences were noted for the other clinical and biological parameters. The proportion of patients fulfilling Pinals' remission criteria was higher in group 1 (25% versus 10.1% in group 2, p = 0.04). The steroid dosage could be significantly reduced in group 1 (-3.4 +/- 6.1 mg/day, p = 0.05) and corticosteroids were stopped in 11 patients. The frequency and type of side effects, as well as the frequency and reasons leading to MTX withdrawal, did not significantly differ between the two groups.
The association of MTX and corticosteroids seems to bring about a greater improvement in the different clinical activity parameters of RA than MTX alone, without any significant increase in the frequency of side effects. These results need to be confirmed in larger scale prospective studies.
研究甲氨蝶呤（MTX）与同时引入的皮质类固醇联合使用是否比单独使用MTX对类风湿关节炎（RA）患者更有效。
28例RA患者（第1组）接受MTX（平均剂量：10±1.4mg/周）与同时引入的皮质类固醇（平均剂量：14.9±5.6mg/天，范围：5 - 25mg/天）治疗，并与251例单独接受MTX治疗的RA患者（第2组，平均剂量：9.8±1.5mg/周）进行比较。研究了临床指标（肿胀和疼痛关节数、晨僵、里奇关节指数）、生物学指标（血沉、C反应蛋白）和放射学参数的变化。缓解根据皮纳尔斯标准定义。基线时，两组之间无显著差异，除了第1组肿胀和疼痛关节数更多（分别为p = 0.03和p = 0.01）。两组之间的MTX总剂量和治疗持续时间（第1组为26±21.8个月，第2组为33.5±27.2个月）无差异。
我们注意到第1组肿胀和疼痛关节数的减少更为明显（p = 0.03）。其他临床和生物学参数无差异。符合皮纳尔斯缓解标准的患者比例在第1组更高（25% 对第2组的10.1%，p = 0.04）。第1组的类固醇剂量可显著降低（-3.4±6.1mg/天，p = 0.05），11例患者停用了皮质类固醇。两组之间副作用的频率和类型，以及导致MTX停药的频率和原因无显著差异。
MTX与皮质类固醇联合使用似乎比单独使用MTX在RA的不同临床活动参数方面带来更大改善，且副作用频率无显著增加。这些结果需要在更大规模的前瞻性研究中得到证实。
