关节腔注射甲氨喋呤治疗类风湿性关节炎

目的：研究用甲氨喋呤（ＭＴＸ）行关节腔注射治疗类风湿性关节炎（ＲＡ）。方法：选择符合１９８７年美国风湿病学会诊断标准的ＲＡ患者３０例，病变较重一侧的关节注入ＭＴＸ２０ｍｇ／次，１次／周；另一侧对称关节为对照。６周后比较注射前后临床指标（晨僵时间、关节指数、握力）和血清学指标（血沉、Ｃ反应蛋白、类风湿因子）的变化。结果：６周后，用ＭＴＸ前后的临床指标和血清学指标变化差异显著（Ｐ＜００１，Ｐ＜００５），ＭＴＸ注射侧较对照侧临床指标变化差异显著（Ｐ＜００１），受治病例全部有效。部分患者在治疗中还可减少或停用甾体及非甾体药物。结论：用ＭＴＸ行关节腔注射治疗ＲＡ有效，尤其适用于寡关节型ＲＡ，且见效快，副反应小。

TREATMENT OF RHEUMATOID ARTHRITIS WITH INTRAARTICULAR INJECTION OF METHOTREXATE

Objective:To study the effect of treating rheumatoid arthritis(RA)with intraarticular injection of methotrexate(MTX).Methods:30 patients in accord with American Rheumatism Association(ARA) criteria for RA were selected.The swelling joint with more severe pain was injected with MTX 20 mg once a week,and the joint on the other side was left as control.The clinical data(morning stiffness,joint grades and grip strength)and serological data(erythrocyte sedimentation rats,C reactive protein and rheumatoid factor)were recorded before and after treatment.Results:After treatment for 6 weeks the patients had significant improvement of morning stiffness,joint grades and grip strength on the injected side.The treatment can also decrease erythrocyte sedimentation rate(ESR),C reactive protein.Some of the patients reduced or stopped taking nonsteroidal antiinflammatory drug(NSAID) and corticosteroid.Conclusion:Intraarticular MTX injection is a quick and effective therapy to treat RA patients,especially to treat those with involvement of only a few joints.The side effect of intraarticular injection of MTX is not marked.