title: High-Dose Intravenous Pulse Methotrexate in Patients With Eosinophilic Fasciitis.
abstract: Eosinophilic fasciitis (EF) is a connective tissue disorder in which conventional treatment leads to disappointing results in a proportion of patients. Therefore, we investigated high-dose intravenous (IV) pulse methotrexate (MTX) as a treatment for EF.
  
  
  
  To examine safety and effects of monthly high-dose IV pulse MTX in EF.
  
  
  
  For this prospective single-arm study, we recruited 12 patients diagnosed with biopsy specimen-proven EF between 2006 and 2009 from the Department of Dermatology and Rheumatology at the Radboud University Medical Centre.
  
  
  
  Intravenous MTX (4 mg/kg) monthly for 5 months with folinic acid rescue 24 hours after MTX administration.
  
  
  
  The primary outcome was improvement of the modified skin score at month 5 vs baseline. Secondary outcomes were durometry, range of motion, visual analog scale scores for disease activity, and 36-Item Short Form Survey health questionnaires.
  
  
  
  Overall, 12 patients (11 women between 37-69 years old) received a median (range) monthly dose of 288 (230-336) mg MTX. Median (range) modified skin score improved from 17.5 (8.0-24.0) at baseline to 8.5 (1.0-20.0) at month 5 (P = .001). Secondary outcome measures improved significantly, except for durometer scores and range of motion of the elbows. Adverse events included gastrointestinal symptoms (n = 9), mild stomatitis (n = 5), and alopecia (n = 4).
  
  
  
  High-dose IV pulse MTX is a safe and effective treatment option in EF.
  
  
  
  clinicaltrials.gov Identifier: NCT00441961.
authors.affiliation: Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands2Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Jorre S
authors.initials: JS
authors.lastname: Mertens
authors.affiliation: Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Manon C
authors.initials: MC
authors.lastname: Zweers
authors.affiliation: Department of Epidemiology, Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Wietske
authors.initials: W
authors.lastname: Kievit
authors.affiliation: Department of Rheumatology, Radboud University Medical Centre & Sint Maarstenskliniek, Nijmegen, the Netherlands.
authors.forename: Hanneke K A
authors.initials: HK
authors.lastname: Knaapen
authors.affiliation: Department of Rheumatology, Westfriesgasthuis, Hoorn, the Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Gerritsen
authors.affiliation: Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, the Netherlands6Department of Rheumatology and Clinical immunology, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Timothy R D J
authors.initials: TR
authors.lastname: Radstake
authors.affiliation: Department of Rheumatology, Radboud University Medical Centre & Sint Maarstenskliniek, Nijmegen, the Netherlands.
authors.forename: Frank H J
authors.initials: FH
authors.lastname: van den Hoogen
authors.affiliation: Department of Rheumatology, Jeroen Bosch Hospital-Hertogenbosch, the Netherlands.
authors.forename: Marjonne C W
authors.initials: MC
authors.lastname: Creemers
authors.affiliation: Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Elke M G J
authors.initials: EM
authors.lastname: de Jong
mesh_terms: D000328:Adult; D000368:Aged; D004802:Eosinophilia / Q000188:drug therapy*; D005208:Fasciitis / Q000188:drug therapy*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D011446:Prospective Studies; D020551:Pulse Therapy, Drug / Q000379:methods; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate