spcsalbibMethotrexate.html

METHOTREXATE E SLE

AGGIORNAMENTI:

Il Methotrexate nel trattamento del LES: selezione di abstract e consigli ai pazienti.

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Record 1 of 14 selected.

Title: Methotrexate use in systemic lupus erythematosus.
Author: Kipen Y; Littlejohn GO; Morand EF
Address: Rheumatology Unit, Monash Medical Centre, Melbourne, Victoria, Australia.
Source: Lupus, 6(4):385-9 1997
Abstract: Low dose pulse oral methotrexate (MTX) is a well established treatment for rheumatoid arthritis, and short term open studies have suggested beneficial effects of MTX in SLE. This study was designed to investigate MTX treatment maintenance rates in SLE using life table analysis, and to determine whether MTX use was associated with a dose reduction of concomitant steroid therapy. All SLE patients managed by physicians affiliated with a single centre were studied cross-sectionally. Information regarding disease variables and drug use were ascertained by interview and chart review. Drug therapy data including dates of treatment and indications for treatment were analysed using Kaplan-Keier life table methods. Among 101 subjects with SLE, 25 MTX treatment episodes were observed in 24 subjects. The period studied totalled 19766 patient-days, with a median (range) duration of observed MTX treatment of 14.4 (5.1-41.6) months. The median (range) initial and peak MTX doses with 7.5 (2.5-10)mg/wk and 10 (7.5-15) mg/week respectively. The principal indication for commencing methotrexate therapy was arthritis. Only two subjects terminated treatment for toxicity, with the most common reason for termination being remission. The cumulative probability of continuing treatment was 68% at 12 months and 61% at 24 months, or 75% and 71% respectively if cessations for remission were excluded. The median (interquartile range) monthly steroid intake during MTX therapy [279.4 (193.4-492.9)mg] was somewhat lower than during the 6 months prior to [298.1 (237.9-531.4)428.8)mg] MTX therapy, but this difference was not significant. A total of 36% of subjects reduced their steroid dose during MTX therapy, but this reduction was not significant. Treatment of SLE with MTX, predominantly for arthritis, was well tolerated over prolonged periods of observation. Toxicity of sufficient severity to lead to treatment termination was uncommon. A subset of subjects were able to reduce steroid intake during MTX therapy, but no overall reduction in steroid dose was observed.
Language: Eng
Unique Identifier: 97318041
MESH Headings: Adult; Arthritis, Rheumatoid (CO/DT); Cross-Sectional Studies; Female; Human; Immunosuppressive Agents (AE/*TU); Life Tables; Lupus Erythematosus, Systemic (*DT); Male; Methotrexate (AE/*TU); Probability; Support, Non-U.S. Gov't
Publication Type: CLINICAL TRIAL; JOURNAL ARTICLE
ISSN: 0961-2033
Country of Publication: ENGLAND

Database: med96-97 -- Record 2 of 14 selected.

Title: Methotrexate in nonrenal lupus and undifferentiated connective tissue disease--a review of 36 patients.
Author: Wise CM; Vuyyuru S; Roberts WN
Address: Department of Internal Medicine, Medical College of Virginia, Richmond 23298-0647, USA.
Source: J Rheumatol, 23(6):1005-10 1996 Jun
Abstract: OBJECTIVE: To determine the efficacy, tolerability, and steroid sparing effect of methotrexate (MTX) in patients with systemic lupus erythematosus (SLE) in clinical practice. METHODS: From a database of 467 patients, we identified all patients with SLE and undifferentiated connective tissue disease (UCTD, 2-3 criteria for SLE) who had received MTX. Details of previous therapy, indications for MTX, efficacy, toxicity, and steroid reduction during MTX therapy were recorded. RESULTS: 21 patients with SLE who had been treated with MTX were identified. The mean weekly MTX dose rose from 7.5 mg at initiation to 13.6 mg at 6 mo and 17.1 mg at 12 mo. A response was seen in 12 of 21 patients, and 7 patients had a sustained 50% reduction in disease activity at the final evaluation. Response was best in patients with dermatitis (5/6), arthritis (6/13), and myositis (1/1), but minimal in patients with central nervous system dysfunction (1/4), serositis (1/3), and isolated fatigue (0/1). Toxicity was noted in 62% of patients, but only 33% discontinued due to toxicity. MTX was continued in 74% of patients at 6 mo and 40% at 12 mo. Steroid dosage was reduced to half the original dose in 9 of 16 patients. A similar pattern of MTX efficacy and toxicity was observed in 15 patients with UCTD. CONCLUSION: MTX is useful in the treatment of some patients with mild manifestations of SLE, with an acceptable toxicity profile, but only modest steroid sparing potential. Patients with dermatitis and arthritis appear to have the best chance of responding to MTX therapy.
Language: Eng
Unique Identifier: 96375842
MESH Headings: Adolescence; Adrenal Cortex Hormones (AD); Adult; Connective Tissue Diseases (*DT); Female; Human; Lupus Erythematosus, Systemic (*DT); Male; Methotrexate (AD/AE/*TU); Middle Age; Retrospective Studies; Treatment Outcome
Publication Type: JOURNAL ARTICLE
ISSN: 0315-162X
Country of Publication: CANADA

Database: med96-97 -- Record 3 of 14 selected.

Title: Methotrexate in patients with moderate systemic lupus erythematosus (exclusion of renal and central nervous system disease).
Author: Gansauge S; Breitbart A; Rinaldi N; Schwarz-Eywill M
Address: Medizinische Klinik und Poliklinik V, Universität Heidelberg, Germany.
Source: Ann Rheum Dis, 56(6):382-5 1997 Jun
Abstract: OBJECTIVES: Methotrexate (MTX) has been used in several autoimmune diseases. Apart from its use in rheumatoid arthritis, MTX has been assessed in small studies in patients with vasculitis, uveitis, and inflammatory bowel disease. The aim of this study was to evaluate the efficacy of MTX in a particular group of patients with systemic lupus erythematosus (SLE). PATIENTS: In an open prospective study 22 patients fulfilling the ACR criteria for SLE were included. Patients had one or more of the following manifestations; active non-destructive polyarthritis, dermatitis, vasculitis of the skin, pleuritis. All patients had been treated with corticosteroids for at least six months without achieving remission. Sixteen patients were taking antimalarial drugs in addition to corticosteroids, which were stopped at the beginning of the trial. Patients with renal and central nervous involvement were excluded from the study. All patients received MTX orally at a dose of 15 mg/week over six months. Corticosteroids were continued. As additional medication only indomethacin up to 100 mg/day was permitted if used before the start of the study. The outcome was evaluated using the SLE disease activity index (SLEDAI). RESULTS: Disease activity was evaluated after six months of MTX treatment. All patients completed the study period. The SLEDAI decreased significantly from mean (SD) 12.2 (3.99) to 4 (3.75) (p = 0.001). The prednisolone dose was reduced from a mean (SD) of 17.4 (12.8) at the beginning to 8.8 (5.36) mg/day at the end point of the study (p = 0.01). MTX was well tolerated. Four patients complained of general malaise. Two patients had transient increases in liver enzymes. In no case did MTX have to be stopped. CONCLUSIONS: In an open prospective study methotrexate was used in SLE patients with particular clinical characteristics. MTX was shown to be effective in reducing disease activity and sparing the dose of corticosteroids. Further controlled studies are necessary.
Language: Eng
Unique Identifier: 97370944
MESH Headings: Adult; Aged; Antibodies, Antinuclear (BL); Blood Sedimentation; Complement 3c (ME); Complement 4 (ME); Drug Administration Schedule; Drug Therapy, Combination; Glucocorticoids, Synthetic (AD); Human; Immunosuppressive Agents (*TU); Lupus Erythematosus, Systemic (*DT/IM); Methotrexate (*TU); Middle Age; Prednisolone (AD); Prospective Studies
Publication Type: CLINICAL TRIAL; JOURNAL ARTICLE
ISSN: 0003-4967
Country of Publication: ENGLAND

Database: med93-95 -- Record 4 of 14 selected.

Title: Systemic lupus erythematosus: predisposition for uterine cervical dysplasia.
Author: Blumenfeld Z; Lorber M; Yoffe N; Scharf Y
Address: Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel.
Source: Lupus, 3(1):59-61 1994 Feb
Abstract: A previous retrospective study has found an increased risk of uterine cervical atypia in women with systemic lupus erythematosus (SLE) who have been treated with cytotoxic drugs. Our objective was to prospectively reveal any increased incidence of cervical atypia in SLE patients and to evaluate the relationship to previous chemotherapy. A total of 39 SLE women were prospectively referred for cytologic PAP smears of the uterine cervix. A significantly higher incidence of cervical atypia was found in SLE women (35.9%) compared with non-SLE control groups (< or = 5%; P < 0.01). No significant difference was found between the incidence of atypia in patients previously treated by cytotoxic medications such as cyclophosphamide pulses or methotrexate (4 of 9) compared with SLE women not receiving cytotoxic drugs (10 of 30). Colposcopically directed biopsies revealed three cases of cervical intraepithelial neoplasia (CIN) I-III (23%) among the cases with atypia. We conclude that women with SLE should have regular cytologic cervical smears because of a significantly increased incidence of atypia, regardless of previous cytotoxic therapy.
Language: Eng
Unique Identifier: 94297613
MESH Headings: Adolescence*; Adult*; Cervix Dysplasia*; Child*; Cyclophosphamide*; Female; Human; Lupus Erythematosus, Systemic*; Methotrexate*; Middle Age*; Prospective Studies*; Risk Factors*; Vaginal Smears*
Publication Type: JOURNAL ARTICLE
ISSN: 0961-2033
Country of Publication: ENGLAND

Database: med93-95 -- Record 5 of 14 selected.

Title: A 2 year, open ended trial of methotrexate in systemic lupus erythematosus.
Author: Wilson K; Abeles M
Address: Department of Medicine, University of Connecticut Health Center, Farmington 06030-1310.
Source: J Rheumatol, 21(9):1674-7 1994 Sep
Abstract: OBJECTIVE. To investigate a possible role for methotrexate (MTX) in the treatment of patients with systemic lupus erythematosus (SLE) who require unacceptably high doses of glucocorticosteroids (GCS) for control of their disease. METHODS. Twelve patients with SLE participated in this open ended prospective study. Patients with active renal or central nervous system (CNS) disease were excluded as were patients with liver disease. Serological variables, SLE disease activity index, joint count, and prednisone dose were serially evaluated. Data were analyzed using paired t test and contingency table analysis. RESULTS. Arthritis was the major persistent problem in 7 patients: 1 patient had recurrent pleuropericarditis, 2 patients had refractory cutaneous lupus rashes and 2 had vasculitis. Three patients discontinued MTX because of side effects. The remaining 9 patients have been treated from 7-26 months. In 6 patients the GCS dose was reduced by an average of 42%. In 1 patient symptoms subsided and joint count was reduced without change in the GCS dose. GCS dosage was increased in 2 patients: 1 with recurrent serositis, 1 with persistent vasculitis. No apparent effect on anti-dsDNA antibodies, complement or erythrocyte sedimentation rate (ESR) was noted. CONCLUSION. MTX appears to be useful in selected patients with SLE, especially those with persistent synovitis.
Language: Eng
Unique Identifier: 95097296
MESH Headings: Adult*; Antibodies, Antinuclear*; Arthritis*; Blood Sedimentation*; Complement*; Drug Administration Schedule*; Drug Therapy, Combination*; Female; Human; Lupus Erythematosus, Systemic*; Male; Methotrexate*; Middle Age*; Prednisone*; Prospective Studies*; Support, U.S. Gov't, P.H.S.; Synovitis*; Vasculitis*
Publication Type: CLINICAL TRIAL; JOURNAL ARTICLE
ISSN: 0315-162X
Country of Publication: CANADA

Database: med93-95 -- Record 6 of 14 selected.

Title: Immunosuppressive drug therapy of systemic lupus erythematosus.
Author: Fox DA; McCune WJ
Address: Division of Rheumatology, University of Michigan Medical Center, Ann Arbor.
Source: Rheum Dis Clin North Am, 20(1):265-99 1994 Feb
Abstract: This article reviews the biologic effects of cyclophosphamide and azathioprine relevant to the treatment of systemic lupus erythematosus (SLE). Other agents used less commonly for SLE, such as methotrexate, chlorambucil, and cyclosporin-A, receive more limited attention. Clinical studies of efficacy and toxicity of these agents in their treatment of SLE are then described in detail.
Language: Eng
Unique Identifier: 94204303
MESH Headings: Azathioprine*; Cyclophosphamide*; Cyclosporine*; Human; Immunosuppressive Agents*; Leukocyte Count*; Lupus Erythematosus, Systemic*; Lymphocyte Subsets*; Lymphocytes*; Mechlorethamine*; Methotrexate*
Publication Type: JOURNAL ARTICLE; REVIEW; REVIEW, ACADEMIC
ISSN: 0889-857X
Country of Publication: UNITED STATES

Database: med93-95 -- Record 7 of 14 selected.

Title: Methotrexate in systemic lupus erythematosus Õsee commentsÕ
Author: Walz LeBlanc BA; Dagenais P; Urowitz MB; Gladman DD
Address: Lupus Clinic, Wellesley Hospital, Toronto, ON, Canada.
Source: J Rheumatol, 21(5):836-8 1994 May
Abstract: OBJECTIVE. Methotrexate (MTX) has been used successfully in the treatment of rheumatoid arthritis, psoriatic arthritis, polymyositis, and Reiter's syndrome. Our objective was to determine the effectiveness of MTX in the treatment of systemic lupus erythematosus (SLE). METHODS. We reviewed retrospectively MTX therapy in 5 patients with SLE, 3 with renal disease and 2 with arthritis. RESULTS. MTX therapy was well tolerated and effective in all 5 patients. CONCLUSION. MTX appears to be both effective and well tolerated in patients with SLE.
Language: Eng
Unique Identifier: 94343374
MESH Headings: Adolescence*; Adult*; Arthritis*; Case Report; Female; Human; Lupus Erythematosus, Systemic*; Lupus Nephritis*; Methotrexate*; Retrospective Studies*; Support, Non-U.S. Gov't; Treatment Outcome*
Publication Type: JOURNAL ARTICLE
ISSN: 0315-162X
Country of Publication: CANADA

Database: med93-95 -- Record 8 of 14 selected.

Title: Successful treatment of interstitial lung disease in systemic lupus erythematosus with methotrexate.
Author: Fink SD; Kremer JM
Address: Division of Rheumatology, Albany Medical College, New York 12208, USA.
Source: J Rheumatol, 22(5):967-9 1995 May
Abstract: Corticosteroids are the accepted medical therapy of interstitial lung disease associated with systemic lupus erythematosus (SLE). We describe a case with a marked improvement in clinical status, pulmonary function testing and gallium lung scanning after treatment of interstitial pulmonary disease associated with SLE with weekly oral methotrexate alone.
Language: Eng
Unique Identifier: 96172501
MESH Headings: Adrenal Cortex Hormones (TU); Adult; Case Report; Female; Gallium Radioisotopes (DU); Human; Immunosuppressive Agents (*TU); Lung Diseases, Interstitial (*DT/ET/RI); Lupus Erythematosus, Systemic (*CO/DT); Methotrexate (*TU)
Publication Type: JOURNAL ARTICLE
ISSN: 0315-162X
Country of Publication: CANADA

Database: med93-95 -- Record 9 of 14 selected.

Title: Central nervous system involvement in systemic lupus erythematosus: a new therapeutic approach with intrathecal dexamethasone and methotrexate.
Author: Valesini G; Priori R; Francia A; Balestrieri G; Tincani A; Airo P; Cattaneo R; Zambruni A; Troianello B; Chofflon M; et al
Address: UniversitÕa La Sapienza, Rome, Italy.
Source: Springer Semin Immunopathol, 16(2-3):313-21 1994
Abstract: In systemic lupus erythematosus (SLE), neurological involvement has been reported to occur with frequencies ranging from 14% (severe cases) to 83% (mild forms included). In spite of early diagnosis and aggressive treatment, neuropsychiatric SLE may represent a serious problem of management. We describe three cases, one with acute transverse myelitis, one with hemiparesis, and one with signs of focal and diffuse cerebral dysfunction, in whom improvement following intrathecal therapy with methotrexate and dexamethasone was observed.
Language: Eng
Unique Identifier: 95232705
MESH Headings: Adolescence*; Adult*; Case Report; Central Nervous System Diseases*; Dexamethasone*; Drug Combinations*; Female; Human; Injections, Spinal*; Lupus Erythematosus, Systemic*; Methotrexate*; Middle Age*
Publication Type: JOURNAL ARTICLE
ISSN: 0344-4325
Country of Publication: GERMANY

Database: med93-95 -- Record 10 of 14 selected.

Title: Methotrexate for steroid-resistant systemic lupus erythematosus.
Author: Hashimoto M; Nonaka S; Furuta E; Wada T; Suenaga Y; Yasuda M; Shingu M; Nobunaga M
Address: Department of Clinical Immunology, Medical Institute of Bioregulation, Kyushu University, Beppu, Japan.
Source: Clin Rheumatol, 13(2):280-3 1994 Jun
Abstract: We here report two patients with steroid-resistant systemic lupus erythematosus (SLE) who were successfully treated with methotrexate (MTX). In both cases, a steroid resistant high fever, associated with mild myositis and pancytopenia were the main common findings, and all these symptoms were alleviated within a few days either by 7.5 mg or 5 mg MTX per week. The number of CD4+ cells increased along with the clinical improvement, whereas the number of CD20+ cells and HLA-DR expressing cells also decreased. Taking into account the side effects of high dose corticosteroids and cyclophosphamides, treatment with a weekly low dose of MTX is known to contribute to an improvement in the long-term prognosis for patients with refractory SLE.
Language: Eng
Unique Identifier: 94374082
MESH Headings: Adult*; Case Report; Drug Resistance*; Female; Human; Lupus Erythematosus, Systemic*; Methotrexate*; Methylprednisolone*; Prednisolone*
Publication Type: JOURNAL ARTICLE
ISSN: 0770-3198
Country of Publication: BELGIUM

Database: med93-95 -- Record 11 of 14 selected.

Title: Update on pharmacotherapy of systemic lupus erythematosus.
Author: Redford TW; Small RE
Address: College of Pharmacy, University of Iowa, Iowa City, USA.
Source: Am J Health Syst Pharm, 52(23):2686-95 1995 Dec 1
Abstract: Established and novel approaches to the pharmacologic management of systemic lupus erythematosus (SLE) are described. SLE is a chronic, multiple-organ-system inflammatory disorder associated with immune system dysfunction. Autoantibodies are produced that react with self-antigens, notably cell membranes and nuclear and cytoplasmic constituents. There are many clinical manifestations, including arthritis, arthralgia, myalgia, skin changes, photosensitivity reactions, fever, anemia, thrombocytopenia, proteinuria, and renal, CNS, and cardiopulmonary involvement. The disease characteristically fluctuates between remission and relapse. Survival has been improving because of new drug treatments and better diagnostic and serologic tests. Minor manifestations can be treated with less toxic agents, such as nonsteroidal anti-inflammatory drugs, sunscreens, topical and intralesional corticosteroids, and antimalarials. Aggressive therapy with high-dose corticosteroids or immunosuppressants is necessary in patients with worsening renal function (lupus nephritis). CNS lupus has responded to various degrees to dexamethasone, methylprednisolone, and cyclophosphamide. Other therapeutic options include methotrexate in corticosteroid-resistant SLE and cyclosporine. The use of monoclonal antibodies is under intensive study. As mortality due to SLE decreases, complications like cardiovascular problems are becoming more prominent; patients may require antihypertensives, cholesterol-lowering drugs, and hypoglycemic agents. The complexity and chronicity of SLE have led to diverse pharmacotherapeutic strategies based on the organ systems involved. Immunologic research may ultimately bring patients greater relief.
Language: Eng
Unique Identifier: 96170553
MESH Headings: Female; Human; Lupus Erythematosus, Systemic (CO/*DT/EP); Lupus Nephritis (CO/DT); Male
Publication Type: JOURNAL ARTICLE; REVIEW; REVIEW, ACADEMIC
ISSN: 1079-2082
Country of Publication: UNITED STATES

Database: med96-97 -- Record 12 of 14 selected.

Title: Intravenous immune globulin for inducing remissions in systemic lupus erythematosus.
Author: Heyneman CA; Gudger CA; Beckwith JV
Address: Idaho Drug Information Center, College of Pharmacy, Idaho State University, Pocatello 83209, USA.
Source: Ann Pharmacother, 31(2):242-4 1997 Feb
Abstract: The evidence supporting the use of long-term IVIG therapy to induce remissions in SLE is unimpressive. The single extant clinical study used an open-label design with 12 patients, no placebo control, and questionable statistical methodology. The lack of definitive clinical studies, however, is tempered by case reports documenting significant improvement and apparent lack of toxicity in patients with SLE treated with IVIG. Standard first-line therapy of active SLE should consist of nonsteroidal antiinflammatory drugs, followed by low-dose corticosteroids and antimalarial compounds. Second-line therapeutic alternatives are the cytotoxic agents methotrexate, azathioprine, or cyclophosphamide. IVIG's primary advantage over these conventional therapies is that, unlike immunosuppressant and cytotoxic drugs, IVIG has not been reported to increase the risk of opportunistic infections. Additionally, IVIG obviates the ovarian/testicular toxicity, hemorrhagic cystitis, and carcinogenicity caused by cyclophosphamide. However, IVIG therapy is extremely expensive. (Approximate average wholesale price is $1800 per dose for a 70-kg patient). Thus, IVIG treatment consisting of 0.4 g/kg/d for 5 consecutive days on a monthly basis should be reserved for patients with active SLE resistant to the first- and second-line therapies. While IVIG-induced acute renal failure is considered rare, the serious nature of this adverse event warrants close monitoring of blood urea nitrogen and serum creatinine during and several days after treatment. Preexisting renal dysfunction should be considered a relative contradiction. Further double-blind multicenter trials are warranted to determine the long-term safety, efficacy, and cost/benefit ratio of using IVIG in SLE.
Language: Eng
Unique Identifier: 97186974
MESH Headings: Adolescence; Adult; Child; Clinical Trials; Female; Human; Immunoglobulins, Intravenous (AD/AE/*TU); Lupus Erythematosus, Systemic (*TH); Male; Middle Age; Remission Induction
Publication Type: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
ISSN: 1060-0280
Country of Publication: UNITED STATES

Database: med93-95 -- Record 13 of 14 selected.

Title: Autoimmune disease. A problem of defective apoptosis.
Author: Mountz JD; Wu J; Cheng J; Zhou T
Address: Multipurpose Arthritis and Musculoskeletal Disease Center, University of Alabama at Birmingham.
Source: Arthritis Rheum, 37(10):1415-20 1994 Oct
Abstract: Human autoimmune diseases share the common feature of an imbalance between the production and destruction of various cell types including lymphocytes (SLE), synovial cells (RA), and fibroblasts (scleroderma). Patients with SLE have increased levels of soluble Fas that inhibit proper apoptosis of lymphocytes. In animal models of autoimmune diseases, mutations of genes involved in apoptosis including Fas, Fas ligand, and the hematopoietic cell phosphatase gene have been identified. Oncogenes, including bcl-2, p53, and myc, that regulate apoptosis are also expressed abnormally. Potent inducers of apoptosis including steroids, azathioprine, cyclophosphamide, and methotrexate are the most efficacious therapies for autoimmune disease currently known. Specific therapies that induce apoptosis without incurring side effects should improve treatment of autoimmune disease.
Language: Eng
Unique Identifier: 95032210
MESH Headings: Antigens, Surface (IM/*ME); Apoptosis (GE/*PH); Autoimmune Diseases (GE/*PP); Autoimmunity; Cell Division; Genes, myc; Genes, p53; Human; Mutation (GE); Proto-Oncogene Proteins (GE); Support, U.S. Gov't, P.H.S.
Publication Type: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
ISSN: 0004-3591
Country of Publication: UNITED STATES

Database: med93-95 -- Record 14 of 14 selected.

Title: Autoimmune connective tissue disease, chronic polyarthritides and B cell expansion: risks and perspectives with immunosuppressive drugs.
Author: Ferraccioli GF; De Vita S; Casatta L; Damato R; Pegoraro I; Bartoli E
Address: Rheumatic Disease Unit, School of Medicine, University of Udine, Italy.
Source: Clin Exp Rheumatol, 14 Suppl 14:S71-80 1996 Jan-Feb
Abstract: Several autoimmune diseases, including Sjögren's syndrome (SS), systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), are characterized by B cell hyperactivity, polyclonal activation, and autoantibody synthesis. Overt B cell clonal expansion occurs in a minority of the patients, while at the tissue level clonotypic B cells may be more easily detected in the majority of patients. The data available suggests that antigen-driven B cell expansion, eventually leading to somatic mutation and transformation, is the main event. Immunosuppressive drugs known to increase chromosomal damage and to lead to earlier transformation should therefore be avoided, unless strictly necessary to preserve vital organ functioning. New immunosuppressive drugs such as methotrexate, cyclosporine A, and Rapamycin are promising for they seem to offer effective control of disease-related organ damage with acceptable side effects. The B cell lymphoproliferative diseases occurring under treatment seem to remit spontaneously after prompt drug withdrawal. Close surveillance, employing new techniques capable of detecting early B or T cell clonal expansion, may allow better monitoring of possible complications. Biological agents such as alpha-interferon and monoclonal antibodies (which are directed against specific immunological mediators and thus target-selected steps of the immune-inflammatory process) have opened promising new research topics in all these diseases.
Language: Eng
Unique Identifier: 96280256
MESH Headings: Animal; Arthritis, Rheumatoid (DT/*IM); B-Lymphocytes (IM); Chronic Disease; Disease Models, Animal; Human; Immunosuppressive Agents (*/CT/TU); Lupus Erythematosus, Systemic (DT/*IM); Mice; Sjogren's Syndrome (DT/*IM)
Publication Type: JOURNAL ARTICLE; REVIEW; REVIEW, ACADEMIC
ISSN: 0392-856X
Country of Publication: ITALY

Patient Education Monograph for Methotrexate

USES:: This medication is used to treat certain types of cancer or to control severe psoriasis or arthritis.
HOW TO USE THIS MEDICATION:: This is a potent medication. Take it exactly as directed by your doctor. Unless your doctor instructs you otherwise, drink plenty of fluids while taking this medication. This helps your kidneys to remove the drug from your body and minimize some of the side effects.
SIDE EFFECTS:: This medication may cause nausea, stomach pain or drowsiness. If these effects persist or worsen, contact your doctor. Report to your doctor promptly mouth sores, diarrhea, fever, persistent sore throat, unusual bleeding or bruising, black stools, rash or enlarged glands/lymph nodes. Unlikely but report promptly yellowing of the eyes/skin, chest pain, flu-like symptoms, dry cough, neck stiffness, vision changes, headache, muscle weakness, mental changes or seizures. Temporary hair loss may occur; normal hair growth should return after treatment has ended. In the unlikely event you have an allergic reaction to this drug, seek medical attention immediately. Symptoms of an allergic reaction include rash, itching, swelling, fever or trouble breathing.
PRECAUTIONS:: Before using this drug, tell your doctor your medical history especially a history of kidney, liver, lung or intestinal diseases, chickenpox (or recent exposure to it), alcohol use and of any allergies, especially drug allergies. As this medication may make you more sensitive to the effects of the sun, avoid prolonged exposure to sunlight or sunlamps. Avoid touching your eyes or inside your nose without first washing your hands to prevent eye infections. Do not have immunizations/vaccinations without consent of your doctor and avoid contact with people who have recently received oral polio vaccine. Avoid alcohol use. Males should insure that effective contracepetive measures are used during and for 3 months after methotrexate treatment. Methotexate should not be used during pregnancy. If you become pregnant or think you may be pregnant, inform your doctor immediately. Use of this drug is not recommended if you wish to become pregnant. Use appropriate contraceptive measures during and for at least one menstrual cycle after methotrexate treatment. Methotrexate is excreted into breast milk. Do not breast-feed while using this drug. Consult your doctor before breast-feeding.
DRUG INTERACTIONS:: Tell your doctor of all over-the-counter and prescription medication you may take especially etretinate, folic acid, phenytoin, aspirin, NSAID (e.g., ibuprofen, naproxen), sulfa medications and of other antibiotics, procarbazine, digoxin, theophylline, probenecid and of alcohol use.
NOTES:: This medication must be used under close medical supervision so your condition can be monitored. Laboratory tests will be done periodically to be sure the drug is working properly and to monitor for possible side effects.
MISSED DOSE:: It is important to use each dose at the scheduled time. If you miss a dose, contact your doctor who will help establish a new dosing schedule. Do not "double-up" the dose to catch up.
STORAGE:: Store this medication at room temperature between; 59 to 86 degrees F (15 to 30 degrees C) away from light and
moisture. Do not store in the bathrom.