Objectives To assess the effect of combination of high doses of Methotrexate and Pulse-therapy of corticosteroids in 12 months¢ trial.
Methods Thirty one patients with systemic rheumatoid arthritis, resistance to basic medication, corticosteroid dependency were included into the study. Intravenous (i.v) pulse-therapy was provided for 3 days by methylprednisolone of 15/mg/kg/d or dexamethasone of 2/mg/kg/d. Methotrexate of 100 mg i.v. was administrated on 7 and 30 days of the treatment, after that all patients were prescribed Methotrexat in dosage of 20 mg i.m. for 11 months.
Results Clinical effects of treatment and the regression of inflammatory activity were rapid and excellent in 1 month and prolonged during 6‑12 months. There was 20% improvement in the joint pain index and joint swelling index in > 95%, 45%, 65% of the patients in a 1, 6, 12 months therapy respectively. In a year was observed the significant decrease of Wilke?s Index activity and Index severity. There were a marked fall in ESR, CRP and TNF. 12 pts had no radiographic progression in one year therapy. Side effects were minimal, In 43% causes were observed dyspepsia.
Conclusion Intravenous pulse of methotrexate and methylprednisolone/dexamethasone in the treatment of severe rheumatoid arthritis appeared to be useful regimen in the treatment of rheumatoid arthritis with systemic manifestations, resistance to basic medication, corticosteroid dependency.