Summary
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gubner, R., August, S., Ginsberg, V. Therapeutic suppression of tissue reactivity: II. Effect of aminopterin in rheumatoid arthritis and psoriasis. Am J Med Sci 1951, 22, 176–182.
Taillan, B., Garnier, G., Castanet, J., Ferrari, E., Pesce, A., Dujardin, P. Lymphoma developing in a patient with rheumatoid arthritis taking methotrexate. Clin Rheumatol 1993, 12, 93–94.
Fox, D.A., McCune, W.J. Immunologic and clinical effects of cytotoxic drugs used in the treatment of rheumatoid arthritis and systemic systemic lupus erythematosus. Ther Autoimmune Dis 1989, 7, 20–78.
Jolivet, J., Cowan, K.H., Curt, G.A., Clendeninn, N.J., Chabner, B.A. The pharmacology and clinical use of methotrexate. N Engl J Med 1983, 309, 1094–1104.
Mitchell, M.S., Wade, M.E., DeConti, R.C., Bertino, J.R., Calabresi, P. Immunosuppressive effects of cytosine arabinoside and methotrexate in man. Ann Intern Med 1969, 70, 535–547.
Rozenszajn, L.A., Radnay, J. The effect of methotrexate on transformation and mitosis of normal human blood lymphocytes in vitro. Blood 1974, 43, 401–409.
Matheson, D.S., Green, B., Hoar, D.I. The influence of methotrexate and thymidine on the human natural killer cell function in vitro. J Immunol 1983, 131, 1619–1621.
Gadeberg, O.V., Rhodes, J.M., Larson, S.O. The effect of various immunosuppressive agents on mouse peritoneal macrophages and on the in vitro phagocytosis of Escherichia coli 04:K3:H5 and degradation of125I-labelled HSA-antibody complexes by these cells. Immunology 1975, 28, 59–70.
Walsdorfer, V., Christophers, E., Shroder, J.M. Methotrexate inhibits polymorphonuclear leukocyte chemotaxis in psoriasis. Br J Dermatol 1983, 108, 451–456.
Sperling, R.I., Coblyn, J.S., Larkin, J.K., Benincaso, A.I., Austen, K.F., Weinblatt, M.E. Inhibition of leukotriene B4 synthesis in neutrophils from patients with rheumatoid arthritis by a single oral dose of methotrexate. Arthritis Rheum 1990, 33, 1149–1155.
Jasin, H.E., Ziff, M. Immunoglobulin synthesis by peripheral blood cells in systemic lupus erythematosus. Arthritis Rheum 1975, 18, 219–228.
Bakke, A.C., Kirkland, P.A., Kitridou, R.C., Quismorio, F.P., Rea, T., Ehresmann, G.R., Horwitz, D.A. T lymphocyte subsets in systemic lupus erythematosus. Arthritis Rheum 1983, 26, 745–750.
Duby, S., Karsh, J., Prchal, J.F. Measurements of red blood cell methotrexate concentrations and lymphocyte subsets during therapy of rheumatoid arthritis. Clin Exp Rheumatol 1985, 3, 5–9.
Weinblatt, M.E., Trentham, D.E., Fraser, P.A., Holdsworth, D.E., Falchuk, K.R., Weissman, B.N., Coblyn, J.S. Long-term prospective trial of low-dose methotrexate in rheumatoid arthritis. Arthritis Rheum 1988, 31, 167–175.
Davidson, J.R., Graziano, F.M., Rothenberg, R.J. Methotrexate therapy for severe systemic lupus erythematosus. Arthritis Rheum 1987, 30, 1195–1196.
Rothenberg, R.J., Graziano, F.M., Grandone, J.T., Goldberg, J.W., Bjarnason, D.F., Finesilver, A.G. The use of methotrexate in steroid-resistant systemic lupus erythematosus. Arthritis Rheum 1988, 31, 612–615.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hashimoto, M., Nonaka, S., Furuta, E. et al. Methotrexate for steroid-resistant systemic lupus erythematosus. Clin Rheumatol 13, 280–283 (1994). https://doi.org/10.1007/BF02249027
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02249027