Combined Therapy of HighlyActive Rheumatoid Arthritis with Methotrexate and Cyclosporin

Overview

Objective:
The objective of the research project was to evaluate the effect of combined therapy withmethotrexate and cyclosporin A in active rheumatoid arthritis refractory to previous monotherapywith methotrexate, and to evaluate the incidence of undesirable effects of this treatment. Method:The investigated group comprised 37 patients with rheumatoid arthritis who were treated for atleast three months with methotrexate, at least 10 mg/week, with an unsatisfactory effect. Thesepatients were given in addition to the mentioned treatment cyclosporin, initial dose 2.5 mg/kg,gradually increasing up to 5 mg/day. The authors evaluated the trend of some parameters (erythro-cyte sedimentation rate, CRP, articular index, HAQ questionnaire) during six months treatment andinvestigated also the development of possible side effects. After completion of the study a completecheck-up examination after another six months was made and the further development of the diseaseand treatment was described in some patients. Results: In all investigated parameters there wasa significant drop as compared with values at the onset of treatment (p < 0.01). During treatment 25manifestations of undesirable therapeutic effects were recorded, incl. in particular hypertension,nephrotoxicity mild hepatopathy, gastrointestinal complaints and infections. In five patients it wastherefore necessary to stop treatment prematurely, in the remainder these complications weremanaged by common therapy. Conclusion: The results provided evidence of a very good effect ofcombined treatment with cyclosporin A and methotrexate. Undesirable effects of this treatmentwhich developed during therapy were in the majority controlled by common therapy and as a ruledid not lead to early termination of treatment.

Key words:
rheumatoid arthritis, DMARDs, cyclosporin A, methotrexate