Kremer J M
Scand J Rheumatol. 1996;25(6):341-4. doi: 10.3109/03009749609065644.
Methotrexate (MTX) has become one of the most widely prescribed second-line agents world-wide for rheumatoid arthritis (RA). Studies have established efficacy in populations which have failed other second-line agents. Although MTX must be considered as a potential hepatotoxin, studies have shown that liver histologic changes can be predicted by monitoring of serum albumin and AST at four to eight week intervals. MTX pulmonary toxicity appears to be more common than liver disease. It most often presents with a subacute course with dry cough and dyspnea with or without fever. Clinicians must be aware of this presentation and withhold the drug when these symptoms appear. MTX may also cause mild renal impairment when used with NSAIDs. This effect has been observed with higher mean weekly doses in the 15 to 20 mg range, but not with a starting dose of 7.5 mg. Although MTX may exhibit a variety of effects in in vitro systems its mechanism of action in patients with RA has not yet been determined.
甲氨蝶呤（MTX）已成为全球范围内治疗类风湿关节炎（RA）最广泛使用的二线药物之一。研究已证实其在其他二线药物治疗失败的患者群体中具有疗效。尽管MTX必须被视为一种潜在的肝毒素，但研究表明，通过每4至8周监测血清白蛋白和AST，可以预测肝脏组织学变化。MTX肺部毒性似乎比肝脏疾病更常见。它最常表现为亚急性病程，伴有干咳和呼吸困难，可伴有或不伴有发热。临床医生必须了解这种表现，并在出现这些症状时停用该药物。MTX与非甾体抗炎药合用时也可能导致轻度肾功能损害。在平均每周剂量较高（15至20毫克范围）时观察到这种效应，但起始剂量为7.5毫克时未观察到。尽管MTX在体外系统中可能表现出多种作用，但其在RA患者中的作用机制尚未确定。
