Clinical Study Of Methotrexate Therapy In The Treatment Of Chronic And Noninfectious Scleritis

Scleritis is a relatively rare inflammation on white sclera of eye, and accompanied by a series of symptoms.According to the anatomical location,scleritis can be divided into two kinds of anterior scleritis and posterior scleritis.Also anterior scleritis can be divided into four subtypes: diffuse scleritis,nodular scleritis,necrotizing scleritis without inflammation(scleromalacia perforans).Anterior scleritis offen complain about eye red and tenderness, and posterior scleritis often for vision loss, sometimes sore eyes.Scleritis offen is middle-aged, more than 35 years old.More women than men are also obvious, about 70% above, about 50% eyes scleritis.There are reports that 39% to 50% scleritis patient with systemic related diseases.The prevalence of scleritis is about 6/100 000, but when the patients with rheumatoid arthritis the prevalence will be increased to 0.2% ~ 0.2%, the wegener granulomatosis can amount to 7%, no ethnic and geographical differences.Scleritis is associated with various autoimmune syndromes, such as rheumatoid arthritis, Wegener granulomatosis, relapsing polychondritis, inflammatory bowel disease, systemic lupus erythematosus and polyarteritis nodosa and so on.In addition to the infectious scleritis according to laboratory tests and drug sensitive test corresponding to anti-infective drugs, while the treatment of noninfectious scleritis no clinically has yet been reached. The preferred drugs are often corticosteroids, but often can not get the best results for many patients, and it is difficult to accept these side effects.The noninfectious scleritis offen occur in middle-aged people, and often develop into chronic.The sick time more than 3 months is defined as a chronic scleritis.Particularly older than 50 years with systemic diseases and vision loss associated with the risk is bigger, so more inclined to use immunosuppressants to treat.This clinical trial research the effect of methotrexate to treat chronic and noninfectious scleritis, because the corticosteroids is the preferred drugs of acute and noninfectious scleritis, we serve the only corticosteroids treatment group as control group, and observation groups used corticosteroids with methotrexate, by comparing to determine whether of methotrexate in the treatment of scleritis efficiently.We divided the observation groups into two groups, observation group 1 and observation group 2.Observation group 1 we use conventional dosages of corticosteroids with methotrexate, and observation group 2 low dosages of corticosteroids with methotrexate.Throughing the comparison to determine whether the methotrexate has steroid-sparing capabilities, can decrease the corticosteroids requirement, thus it can reduce the side effects of corticosteroids, etc.For the treatment of chronic and noninfectious scleritis provides new ideas. Objects and MethodsWe conducted a retrospective review of 90 patients(136 eyes) treated for chronic and noninfectious scleritis between February 2011 and February 2015 at the fourth affiliated hospital of Zhengzhou University.The diagnostic basis of scleritis according to GeJian editor in chief of the second edition of journal of ophthalmology teaching.The selected patients were divided into three groups randomly: control group、observation group 1and observation group 2.And the number of three groups were 30 patients.The control patients used dexamethasone sodium phosphate injection intravenous drip, generally for 5 mg/d.We gave patients methlprednisolone sodium succinate when the inflammatory response severely, general is 500 mg/d;If the conditions became stable instead of prednisone acetate tablets, general is 1 mg/kg.(d) morning meal,and gradually reduced, the reduction of 2.5 ~ 5 mg every 2 weeks.The observation group 1 gave methotrexate generally 7.5 ~ 15 mg per week po;We gave methotrexate injection impact therapy when the inflammatory response severely, generally 5 mg/w. If uncontrolled inflammation, impacting again after a week.And using dexamethasone sodium phosphate injection intravenous drip, generally for 5 mg/d.We gave patients methlprednisolone sodium succinate when the inflammatory response severely, general is 500 mg/d;If the conditions became stable instead of prednisone acetate tablets, general is 1 mg/kg.(d) morning,and gradually reduced, the reduction of 2.5 ~ 5 mg every 2 weeks.The observation group 2 gave methotrexate generally 7.5 ~ 15 mg per week po;We gave methotrexate injection impact therapy when the inflammatory response severely, generally 5 mg/w. If uncontrolled inflammation, impacting again after a week.And using dexamethasone sodium phosphate injection intravenous drip, generally lower than 5 mg/d.If the conditions became stable instead of prednisone acetate tablets, general is 0.5 mg/kg.(d) morning,and generally lower than 20 mg/d,and gradually reduced, the reduction of 2.5 mg every 4 weeks.Maintenance dose of prednisone general is 10 mg/d.We observed the three groups of patients the best corrected visual acuity, inflammation control, drugs side effects and relapse after treatment 3 months, 6 months, 1 year.We used the SPSS version 19.0 software for statistical analyses.Compared multiple sets of independent sample single order data using the Kruskal- Wallis test, and multiple sets of two-way disorderly data using χ2 test. Using the χ2 test comparison of Counting information between groups. Test level α= 0.05. Results1. Inflammation controlWe test 3 months inflammation control condition of Kruskal Wallis test, there was no statistically significant difference between the three groups(P > 0.05).We test 6 months and 1 year inflammation control condition of Kruskal Wallis test, the differences were statistically significant between the three groups(P < 0.05).2.Vision recoveryWe test 3 months and 6 months vision recovery condition of Kruskal Wallis test, there were no statistically significant difference between the three groups(P > 0.05). We test 1 year vision recovery condition of Kruskal Wallis test, the difference was statistically significant between the three groups(P < 0.05).3.Drug side effectsWe test 3 months and 6 months drug side effects condition of χ2 test, there were no statistically significant difference between the three groups between the three groups(P > 0.05).We test 1 year drug side effects of χ2 test, the difference was statistically significant between the three groups(P < 0.05).4. RelapseWe test 1 year relapse of χ2 test, the difference was statistically significant between the three groups(P < 0.05).Through the experiment we can observed that the observation group 1 and the observation 2 had the better effect than the control group in the inflammation control,vision recovery and relapse conditions.While the observation 2 and the control group had the less than the observation 1 in the drug side effects conditions.The overall effect of the observation group 1 is better than the control group and the observation group 2.In conclusion can be concluded that the effect of the low dosages of corticosteroids with methotrexate and the conventional dosages of corticosteroids with methotrexate is consistent.Both are more effective than the only corticosteroids. The drug side effects of the low dosages of corticosteroids with methotrexate and the only corticosteroids is consistent.Both are less than the conventional dosages of corticosteroids with methotrexate.So the low dosages of corticosteroids with methotrexate is better than the other two groups. ConclusionMethotrexate is a well-tolerated therapy which can reduce these inflammation successfully in the treatment of chronic and noninfectious scleritis.Methotrexate has steroid-sparing capabilities, can decrease the corticosteroids requirement, thus reduce drug side effects,and can strengthen the anti-inflammatory effects of associated with corticosteroids.