Ali A A, Iqbal M P, Hussain M A, Mehboobali N, Beg J A, Rahbar M H
Department of Medicine, Aga Khan University, Karachi.
J Pak Med Assoc. 1998 Jan;48(1):3-6.
In this study we report our two years experience of methotrexate (MTX) in the management of rheumatoid arthritis (RA) at the Aga Khan University Hospital, Karachi. We studied the clinical course of 124 RA patients. The mean age was 44 +/- 11 years (range 19-72) and mean duration of RA was 5 +/- 4 years (range 0.3-25). Female to male ratio was 10:2.4 (100F:24M). All of them were diagnosed according to the criteria set by American Rheumatism Association. The mean value of ESR was 60 +/- 30 (Range 3-128). Fifty one percent had severe disease (> 10 joints involved and evidence of erosions and deformities). Twenty-one patients had extra-articular manifestations. None of them had received MTX previously. Their kidney and liver functions were assessed to be normal. Patients were divided into two groups. One group (n = 92) received MTX (7.5-10 mg/week) as initial treatment, while the other group (n = 32) was given other disease modifying anti-rheumatic drugs (penicillamine, salazopyrin, gold, or chloroquine) followed by MTX. Assessment of the treatment outcome and development of any adverse reactions was carried out at 3-month interval over an average period of 1 year. Assessment of the treatment outcome in the group which received MTX as initial drug revealed the response to be excellent in 13%, good in 70%, fair in 11% and variable in 4%. In the group which received MTX as second-line of therapy, 59% of the patients had the response from good to excellent, while 25% of the patients exhibited poor to fair response. Regarding side-effects of MTX treatment, 57% exhibited none, while 35% had nausea and vomiting. Alopecia was the next common toxicity in these patients. Two individuals had abnormal liver function tests (value twice more than normal), while one developed lung fibrosis. MTX despite its adverse effects in some of the patients is still an effective, well tolerated and inexpensive disease modifying drug in RA.
在本研究中，我们报告了在卡拉奇阿迦汗大学医院使用甲氨蝶呤（MTX）治疗类风湿关节炎（RA）的两年经验。我们研究了124例RA患者的临床病程。平均年龄为44±11岁（范围19 - 72岁），RA平均病程为5±4年（范围0.3 - 25年）。男女比例为10:2.4（100名女性:24名男性）。所有患者均根据美国风湿病协会制定的标准进行诊断。血沉（ESR）平均值为60±30（范围3 - 128）。51%的患者患有严重疾病（累及超过10个关节且有侵蚀和畸形证据）。21例患者有关节外表现。他们之前均未接受过MTX治疗。评估显示他们的肝肾功能正常。患者被分为两组。一组（n = 92）接受MTX（7.5 - 10毫克/周）作为初始治疗，而另一组（n = 32）先给予其他改善病情抗风湿药物（青霉胺、柳氮磺胺吡啶、金制剂或氯喹），随后给予MTX。在平均1年的时间里，每隔3个月对治疗结果和任何不良反应的发生情况进行评估。对以MTX作为初始药物治疗组的治疗结果评估显示，13%的患者反应极佳，70%的患者反应良好，11%的患者反应一般，4%的患者反应不一。在以MTX作为二线治疗的组中，59%的患者反应从良好到极佳，而25%的患者反应从差到一般。关于MTX治疗的副作用，57%的患者无副作用，而35%的患者出现恶心和呕吐。脱发是这些患者中第二常见的毒性反应。2例患者肝功能检查异常（值高于正常两倍），1例患者出现肺纤维化。MTX尽管在一些患者中有不良反应，但在RA治疗中仍然是一种有效、耐受性良好且价格低廉的改善病情药物。
