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Patients with rheumatoid arthritis (RA) are usually treated with a combination of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying anti-rheumatic drugs (DMARDs). The early use of DMARDs such as methotrexate (MTX) after diagnosing RA is recommended according to the recent guideline for the diagnosis and treatment of RA in Japan. 1, 2) The immunosuppressive and anti-inflammatory effects of MTX show pathological improvement of the synovial membranes in RA patients. 3) Serious adverse effects by drug interactions with MTX include interstitial pneumonia, bone-marrow suppression, infectious disease, and hepatic disorders were reported. 4, 5) In terms of MTX dosage, more than 6 mg/week accounts for 61.6% among the fatal adverse cases reported in Japan. 5) Several NSAIDs suppress the uptake of MTX using the organic anion transporter (OAT) and multidrug resistance-associated protein by the kidney. 6) Elevated blood concentration of MTX by the administration of NSAIDs has been reported with high-dose (more than 1000 mg) MTX for the treatment of acute leukemia and malignant lymphoma. 7) MTX at a low dosage co-treated with NSAIDs for RA patients also caused cytopenia. 8) Meanwhile, it has also been reported that the interaction of MTX and NSAIDs would be insignificant if NSAIDs were used together at a low dosage of MTX. 9) Few reports have discussed the effect of anti-in ammatory drugs on MTX dosage changes. In this study, we retrospectively investigated the effect of NSAIDs on MTX dosage changes in RA patients. Because corticosteroids

iryō yakugaku/iryou yakugaku

Effect of Non-Steroidal Anti-Inflammatory Drugs on Methotrexate Dosage, Corticosteroid Dosage, Rheumatoid Arthritis Activity and Laboratory Data in Patients with Rheumatoid Arthritis