Danieli M G, Fratini M, Rossetti L, Giovagnoni A, Amici F, Danieli G
Istituto di Clinica Medica Generale, Università, Ancona.
Recenti Prog Med. 1998 Jan;89(1):7-13.
Rheumatoid arthritis (RA) is a chronic multisystemic disease affecting mainly the joints and characterised by a poor prognosis. In a four month open study we evaluated the efficacy and tolerability of a combination therapy in 14 patients with active and refractory RA (non responsive to MTX or CsA monotherapy). After three pulses of methyl-prednisolone (125 mg/die i.v. for 3 days), at day the 4 patients received methotrexate (MTX 15/mg/week p.os) and cyclosporine (CsA 3 mg/kg/day p.os). At the end of treatment period, patients had a statistically significant improvement in the tender-joint count (Ritchie Index) in the swollen-joint count and in the pain as recorded on a 100-mm visual-analogue scale. Following the criteria of the American College of Rheumatology for response to treatment in RA, 6 patients (60%) met these criteria, whereas 2 had a worsening. We could not detect any clear difference in serological parameters (ESR, CRP and Hb levels) between the beginning and the end of the therapy. A significant difference in the score of edema/joint effusion was documented at the RM analysis. Side-effects were not substantially increased as compared to MTX or CsA in single therapy. Combination therapy with CsA and MTX seems to be a safe and effective treatment for patients with active and refractory RA.
类风湿关节炎（RA）是一种主要影响关节的慢性多系统疾病，预后较差。在一项为期四个月的开放性研究中，我们评估了联合治疗对14例活动性难治性RA患者（对甲氨蝶呤或环孢素单药治疗无反应）的疗效和耐受性。在给予三次甲泼尼龙冲击治疗（静脉注射125mg/天，共3天）后，从第4天起患者接受甲氨蝶呤（口服15mg/周）和环孢素（口服3mg/kg/天）治疗。在治疗期结束时，患者的压痛关节计数（里奇指数）、肿胀关节计数以及在100mm视觉模拟量表上记录的疼痛程度均有统计学意义的改善。按照美国风湿病学会关于RA治疗反应的标准，6例患者（60%）达到这些标准，而2例病情恶化。我们未发现治疗开始和结束时血清学参数（血沉、C反应蛋白和血红蛋白水平）有任何明显差异。在随机模型分析中记录到水肿/关节积液评分有显著差异。与甲氨蝶呤或环孢素单药治疗相比，联合治疗的副作用并未显著增加。环孢素与甲氨蝶呤联合治疗似乎是活动性难治性RA患者的一种安全有效的治疗方法。
