HIGH DOSE METHOTREXATE FOR OCULAR LESIONS OF BEHCET’S DISEASE. PRELIMINARY SHORT-TERM RESULTS ON 23 PATIENTS.


Abstract: Introduction: methotrexate in weekly low dose pulse of 7.5 mg has long proved its efficacy in the treatment of ocular lesions. During the 1998 ACR congress where we presented our data on 262 patients it was suggested the high dose of 15 mg. This is the short-term result of that study. Materials and Methods: MTX was used as 15 mg weekly. Prednisolone was associated as 0.5 mg/kg/ daily. The visual acuity (VA), the Disease Activity Index (DAI) of anterior uveitis (AU), posterior uveitis (PU), retinal vasculitis (RV), and the Total Adjusted Disease Activity Index (TADAI) were compared in men and women by the Student t test. Results: The mean follow-up time was 9.1 months. For VA, 68%18.1 (confidence interval at 95%) of the eyes improved, 14%13.5 were stabilized, and 18%14.8 were aggravated. The mean VA improved from 5 to 6.7 (t=3.299, p=0.003). For AU, 95%11 of the eyes improved, and 5% were aggravated. The mean DAI for AU improved from 2.9 to 0.4 (t=4.388, p=0.0004). For PU, 94%9 of the eyes improved and 6% were stabilized. The mean DAI for PU improved from 1.8 to 0.4 (t=9.292, p<0.0001). For RV, 60%20 of the eyes improved, 16%15 were stabilized, and 24%18 were aggravated. The mean DAI for RV improved from 2 to 1.1 (t=2.579, p=0.016). For TADAI, 87%14 of patients improved, 9%12 were stabilized, and 4%9 were aggravated. The mean TADAI improved from 24.4 to 12.1 (t=5.962, p<0.0001). Conclusion: High dose MTX was very efficient in ocular lesions of Behcet’s Disease. The improvement was significantly higher than with the low dose.