Uso de metotrexato en pacientes con lupus eritematoso sistémico Methotrexate use in patients with systemic lupus erythematosus

Background: In the past ten years, methotrexate (MTX) has appeared as an alternative for the treatment of systemic lupus erythematosus (SLE). Aim: To evaluate the use of MTX and the results of treatment in a group of patients with SLE. Patients and Methods: Retrospective review of 426 files of patients with SLE. Of these, all patients treated with MTX were selected. A review protocol was designed, stating sex, age, time of disease evolution, previous treatment, MTX prescription, doses, effectiveness and side effects. Results: Seven patients were selected. All were women, with an age range of 26 to 62 years old and with 5 to 34 years of disease evolution. Previous treatment with non steroidal anti-inflammatory drugs, steroids, hydroxychloroquine and azathioprine ranged from 6 to 631 months (average=147.3). Persistent joint and/or skin manifestations were the main cause for the use of MTX. The dose ranged from 7.5 to 15 mg and the treatment lapse from 6 to 106 months. It was effective in all patients, allowing a reduction in prednisone doses. Two patients experienced a rise in serum transaminases and one had gastric intolerance, that required treatment discontinuation. Conclusions: MTX is rarely used in SLE. Its main prescription and effectiveness is in joint and skin manifestations, allowing to decrease steroid doses. However, side effects are frequent (Rev Méd Chile 2004; 132: 195-201)