Totokawa S, Furuya T, Nakajima A, Suzuki T, Kashiwazaki S
Institute of Rheumatology, Tokyo Women's Medical College.
Ryumachi. 1997 Oct;37(5):681-7.
The effectiveness of methotrexate (MTX) in treatment of rheumatoid arthritis (RA) was evaluated by following the course of 232 cases. The number of cases in which MTX treatment was assessed as effective amounted to 149 (64.2%), and among these the number of cases in which the effect was excellent amounted to 59 (25.4%). As for the time required to achieve the therapeutic effect, effectiveness was evident within one month in most cases and the more prominent was the result, the shorter was the time required to achieve the effect. In analysis of it's effectiveness, no relationship to the patient's background such as morbidity period, the extent of inflammation, or the period of administration of anti-rheumatic drugs was observed and this drug seems promising for treatment of severe inflammation in cases of RA with prolonged course enabling application to a wide range of patients. Also, therapeutic effectiveness was observed in a group of elderly patients, who were more than 65 years old. However, in such cases, MTX should be administered carefully because of its reported strong adverse effects. Its effectiveness and adverse effects have been shown to be dose-dependent. Therefore, as the optimum dosage of MTX, it is recommended to administer a dose of 5.0 mg/week initially for an evaluation period of two months and in those cases in which no effect is observed, the dose is then increased to 7.5 mg/week.
通过对232例类风湿关节炎（RA）患者的病程跟踪，评估了甲氨蝶呤（MTX）治疗类风湿关节炎的有效性。MTX治疗被评估为有效的病例数为149例（64.2%），其中效果优异的病例数为59例（25.4%）。至于达到治疗效果所需的时间，大多数病例在一个月内就有明显效果，效果越显著，达到效果所需的时间越短。在分析其有效性时，未观察到与患者背景如发病期、炎症程度或抗风湿药物给药期之间的关系，这种药物对于病程较长的RA严重炎症病例的治疗似乎很有前景，能够应用于广泛的患者群体。此外，在一组65岁以上的老年患者中也观察到了治疗效果。然而，在这些情况下，由于据报道MTX有较强的不良反应，应谨慎给药。其有效性和不良反应已显示出剂量依赖性。因此，作为MTX的最佳剂量，建议最初以5.0毫克/周的剂量给药，进行两个月的评估期，在未观察到效果的情况下，然后将剂量增加到7.5毫克/周。
