Müge AYDIN TUFAN, Emine ERSÖZLÜ BOZKIRLI, Hamide KART, Ahmet YÜCEL

Romatoid artrit yönetiminde subkutan yüksek doz metotreksat tedavisinin etkisi

Amaç: Metotreksat (MTX), romatoid artrit (RA) için hala ana tedavi seçeneğidir. Tek başına veya diğer ilaçlarla kombinasyon halinde uygulandığında ilaç uygulama yolları ve dozajı konusunda fikir birliği yoktur. Bu çalışma, RA yönetiminde erken dönemde yüksek doz subkutan (SC) MTX içeren bir kombinasyon tedavisinin etkinliğini belirlemeyi amaçlamaktadır. Gereç ve Yöntem: Yeni tanı almış kırk beş RA’lı hasta rastgele iki gruba ayrıldı. İlk 4 haftada, haftada 12,5 mg SC MTX alan hastalar "düşük doz grubu" olarak tanımlandı. İlk 4 haftada, haftada 25 mg SC MTX alan hastalar "yüksek doz grubu" olarak tanımlandı. Daha sonra her iki gruptaki hastalar haftada 12.5 mg oral MTX ile devam etti. Hastalara ait başlangıç, 3. ay ve 6. ay klinik ve laboratuvar bulguları, hastalık aktivite skorları ve yanıt oranları kaydedildi. Bulgular: İki grup arasında 3. ay bulguları açısından anlamlı bir fark yoktu. 6. Ay değerleri açısından istatistiksel olarak anlamlı değişiklikler saptandı. Değerler düşük ve yüksek doz gruplarında şu şekildeydi: ortalama DAS28-CRP (3.5'e karşı 2.7; p = 0.01), VAS ağrı skoru (3.3'e karşı 1.6; p = 0.02) ve TJC28 (3'e karşı 1.5; p = 0.04), sırasıyla. Sonuç: Bu çalışma, erken dönemde yüksek doz SC MTX uygulamasının, hastalık aktivitesini etkili bir şekilde kontrol ettiğini ve RA hastalarında yaşam kalitesini arttırdığını göstermiştir.

Anahtar Kelimeler:

İlaç uygulama yolları, , metotreksat, romatoid artrit,

Effect of subcutaneous high-dose methotrexate treatment on the management of rheumatoid arthritis

Purpose: Methotrexate (MTX) is still the main treatment option for rheumatoid arthritis (RA). There is no consensus on drug administration routes and dosage when administered alone or in combination with other drugs. This study aims to identify the effects of early administration of a combination therapy containing high dose subcutaneous (SC) MTX on RA management. Materials and Methods: Forty-five patients with RA who newly diagnosed were divided into two groups randomly. The patients who took 12.5 mg SC MTX per week in the first 4 weeks defined as a "low dose group". The patients who took 25 mg SC MTX per week in the first 4 weeks defined as a "high dose group". Then, patients of both groups continued with 12.5 mg oral MTX per week. Clinical and laboratory findings, disease activity scores and response rates of the patients were recorded at the beginning, 3rd months and 6th months. Results: There was no significant difference between the two groups at 3rd month’s values. There were statistically significant improvements at 6th month’s values. Values were as follows in low and high dose groups: mean DAS28-CRP (3.5 vs 2.7), VAS pain score (3.3 vs 1.6), and TJC28 (3 vs 1.5), respectively. Conclusion: Early administration of high-dose SC MTX effectively controls disease activity and increases the quality of life in RA patients.

Keywords:

Drug administration routes, methotrexate, rheumatoid arthritis, ,

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