Methotrexat – Dreh- und Angelpunkt in der Therapie der rheumatoiden Arthritis

 

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Zusammenfassung

Methotrexat steht im Mittelpunkt der Therapie der rheumatoiden Arthritis. Neues gibt es beim Verständnis des Wirkmechanismus: Intrazelluläre Polyglutamierung aktiviert das Methotrexat-Molekül. Das Ausmaß dieses Schrittes ist mit dem Ansprechen der Therapie assoziiert. Auch wurde festgestellt, dass bereits relativ niedrige Dosen von Methotrexat ausreichen um die Wirkung von Methotrexat als Komedikation von TNF-alpha-Hemmern zu gewährleisten. Schließlich weisen die Beobachtung von Langzeitkohorten darauf hin, dass Methotrexat die Mortalität bei rheumatoider Arthritis auch unabhängig von der Wirkung auf die Krankheitsaktivität reduziert.

Abstract

Methotrexate is in the centre of the treatment of rheumatoid arthritis. There are new insights in the understanding of its mechanism: intracellular polyglutamation activates the methotrexate molecule. The magnitude of this step is associated with response to the treatment. Further on, it was found that even low doses of methotrexate are sufficient to guarantee its effect as comedication of TNF-inhibitors. Finally, from the follow-up of long term cohorts it seems that methotrexate reduces mortality in rheumatoid arthritis independently from its effect on disease activity.

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