title: Methotrexate in ocular manifestations of Behcet's disease: a longitudinal study up to 15 years.
abstract: BACKGROUND
  Ocular manifestations of Behcet's disease (BD) need aggressive treatment to prevent severe loss of vision or blindness. Cytotoxic drugs are the main therapeutic agents and the first line treatment. Methotrexate is the least toxic, used mainly for posterior uveitis. We present here the outcome of eye lesions with methotrexate and prednisolone, in a longitudinal study of up to 15 years, on 682 patients (5447 eye-years of follow-up).
  
  
  METHODS
  Methotrexate was started at 7.5-15 mg/week. Prednisolone was added at 0.5 mg/kg/daily, then adjusted as needed.
  
  
  METHODS
  (i) fulfilling the International Criteria for Behcet's Disease; and (ii) having active posterior uveitis (PU). Visual acuity (VA) was calculated on a scale of 10. Activity indexes were calculated for PU and retinal vasculitis (RV) for each eye. Total Inflammatory Activity Index (TIAI) demonstrating the inflammatory index of both eyes of the patient, and Total Adjusted Disease Activity Index (TADAI) showing both TIAI + VA were also calculated.
  
  
  RESULTS
  Overall results: the mean VA improvement was 0.4 (P < 001), PU 1.2 (P < 0.001) and RV 0.6 (P < 0.001). VA improved in 46.5%, PU in 75.4%, and RV in 53.7% of eyes. TIAI improved in 74% of patients and TADAI in 69.4%. VA was aggravated in 37.2%, PU in 11.1%, and RV in 30.3% of eyes. TIAI was aggravated in 17.4% and TADAI in 21.6% of the patients. The remaining kept their baseline values.
  
  
  CONCLUSIONS
  All parameters improved, PU better than RV. Improvement of VA was the least, mainly due to secondary cataracts.
authors.affiliation: Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Fereydoun
authors.initials: F
authors.lastname: Davatchi
authors.forename: Hormoz
authors.initials: H
authors.lastname: Shams
authors.forename: Farhad
authors.initials: F
authors.lastname: Shahram
authors.forename: Abdolhadi
authors.initials: A
authors.lastname: Nadji
authors.forename: Cheyda
authors.initials: C
authors.lastname: Chams-Davatchi
authors.forename: Bahar
authors.initials: B
authors.lastname: Sadeghi Abdollahi
authors.forename: Tahereh
authors.initials: T
authors.lastname: Faezi
authors.forename: Massoomeh
authors.initials: M
authors.lastname: Akhlaghi
authors.forename: Farimah
authors.initials: F
authors.lastname: Ashofteh
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001528:Behcet Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D058442:Capsule Opacification / Q000209:etiology; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008137:Longitudinal Studies; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D011239:Prednisolone / Q000627:therapeutic use; D020127:Recovery of Function; D012042:Registries; D031300:Retinal Vasculitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014606:Uveitis, Anterior / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D015866:Uveitis, Posterior / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014792:Visual Acuity / Q000187:drug effects*
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011239:Prednisolone; D008727:Methotrexate
keywords: Behcet's disease; cytotoxic therapy; methotrexate; ocular manifestations; steroid therapy