课件：系统性红斑狼疮SLE医学课件.ppt

The literature on use of methotrexate in SLE was recently reviewed by Sato.[30]Among 14 studies there was only one small, open study (published in abstract form) that specifically addressed its use in lupus nephritis.[31] Ten patients with proliferative lupus nephritis resistant to corticosteroids and intravenous cyclophosphamide were treated with weekly doses of 7.5 to 15mg methotrexate. After 8 months of follow-up, the authors reported reductions of both proteinuria (4.6–1.4 g/day) and daily dose of prednisone (17.5–6.4 mg/day). Large randomised trials have not been performed. Methotrexate in lupus nephritis: an uncontrolled study, preliminary results [abstract].Arthritis Rheum 1992; 34: S107 * go Only one pilot study addresses the efficacy of cyclosporin in proliferative lupus nephritis specifically.[ 33] In this study, eleven patients with class IV lupus nephritis were treated with cyclosporin 5 mg/kg/day. In eight of them previous therapy with cyclophosphamide or azathioprine was ineffective or had serious adverse effects. After 1 year, overall disease activity had improved significantly, proteinuria had dropped from 9.1 to 1.7 g/day and repeated kidney biopsies showed significant histological improvement in the majority of patients. The authors regard cyclosporin as a possible potent drug for reducing SLE activity, including renal disease. Of importance is the recognition that cyclosporin can reduce proteinuria irrespective of its cause. This implies that a reduction in proteinuria during cyclosporin treatment of patientswith lupus nephritis does not necessarily equal a beneficial anti-inflammatory response. Effect of cyclosporin A treatment on the activity and renal involvement of systemic lupus erythematosus: a pilot study. Lupus 1998; 7: 29-36 * go go go go go go go go go go go go go go go go go go go go go go go go go go go The keynote publication in 1986[15] of randomised trials performed at the NIH has set some kind of gold standard for treatment o