Intrathecal injection with methotrexate plus dexamethasone in the treatment of central nervous system involvement in systemic lupus erythematosus.
OBJECTIVE
To investigate the effect of intrathecal injection (i.t.) with methotrexate (MTX) plus dexamethasone (DXM) in treating central nervous system involvement in systemic lupus erythematosus (CNS lupus).


METHODS
Twenty-four CNS lupus patients that were refractory to conventional steroid therapy were selected for i.t. with MTX 10-20 mg plus DXM 10-20 mg. The effects and side effects of i.t. were closely observed.


RESULTS
The symptoms and signs of 22/24 (91.7%) CNS lupus patients receiving i.t. improved considerably. Cerebrospinal fluid pressure, protein and WBC levels declined from 201.5 +/- 155.4 mm H2O, 145.2 +/- 87.6 mg/dl and 25.1 +/- 14.3/mm3 to 128.7 +/- 108.1 mm H2O, 60.8 +/- 38.3 mg/dl and 6.8 +/- 2.1/mm3 respectively. Transient side effects were observed in 4 patients: 1 with itching sensation of lower limbs, 2 with headache and 1 with incontinence.


CONCLUSIONS
I.t. with MTX plus DXM is a promising method for treating CNS lupus and deserves further investigation.
Dong
Y
Y
Department of Rheumatology, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, East City, Beijing 100730, China.
Zhang
X
X
Tang
F
F
Tian
X
X
Zhao
Y
Y
Zhang
F
F
D000293:Adolescent; D000328:Adult; D001927:Brain Diseases / Q000188:drug therapy*; D002648:Child; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged
D003907:Dexamethasone; D008727:Methotrexate