Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a prospective randomized study, 21 patients with an unruptured tubal pregnancy were treated with local and systemic injection. On the day of diagnosis, methotrexate (MTX) (1 mg/kg) or sulprostone (500 micrograms) were injected into the gestational sac under transvaginal sonographic control. The systemic component consisted of an intramuscular injection of MTX (1 mg/kg) 3, 5, and 7 days after local injection or of sulprostone (500 micrograms) on the 1st 2 postlocal injection days. Methotrexate therapy was successful in 8 of 12 patients and sulprostone therapy in 6 of 9. Laparoscopy was then performed on the 7 unsuccessful patients: 3 of them had pain and hemoperitoneum and 4 of them had rising human choriogonadotropin (hCG) levels. One stomatitis after MTX and one cramping abdominal pain were observed. Thirteen of 14 successfully treated patients had initial hCG levels less than 5,000 mIU/mL. At subsequent hysterosalpinography, 13 of 14 patients had normal tubal configuration and patency. Three of 10 patients who desired another pregnancy had already achieved a normal intrauterine pregnancy. These results suggest that MTX and sulprostone were equally effective, and medical approach for the unruptured ectopic pregnancy may be restricted to patients with hCG less than 5,000 mIU/mL.
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PMID:Conservative management of ectopic pregnancy: prospective randomized clinical trial of methotrexate versus prostaglandin sulprostone by combined transvaginal and systemic administration. 200 98

Methotrexate is an effective agent for the treatment of rheumatoid arthritis. It is now widely prescribed for patients who have not tolerated or responded to gold compounds or penicillamine. Minor adverse reactions are common, and fatal pulmonary toxicity or cirrhosis can occur. The drug does not produce disease remissions, but continued administration helps reduce pain, stiffness and swelling. Within the past year, the Food and Drug Administration has approved methotrexate for use in treating rheumatoid arthritis.
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PMID:Methotrexate in the treatment of rheumatoid arthritis. 267 14

An 11-year-old boy, treated for acute lymphatic leukemia at the age of 2 with intrathecal injections of Methotrexate, presented with a two year history of pain and signs of lumbo-sacral lesion. MRI, myelography and myelo-CT demonstrated an intradural L4-L5 epidermoid tumor which was removed. Iatrogenic implantation of epithelial cells at the age of two with lumbar punctures is most likely. Decline in incidence of lumbar iatrogenic epidermoid cysts, now an exceedingly rare event, is probably related to improved needles for lumbar punctures.
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PMID:Iatrogenic intraspinal epidermoid tumor: myelo-CT and MRI diagnosis. 277 79

Disease-modifying antirheumatic drugs are used to modify or alter the rheumatoid arthritis disease process. Disease-modifying antirheumatic drugs do not demonstrate the characteristic analgesic, antipyretic, and anti-inflammatory actions of the nonsteroidal anti-inflammatory drugs, since weeks or months of treatment are required before clinical benefit is observed. Although they have not been proved to delay, prevent, or reverse articular damage, therapy with disease-modifying antirheumatic drugs, when successful, is associated with decreased pain and joint swelling and improved function. Disease-modifying antirheumatic drugs and cytotoxic agents should not be considered as routine treatment for patients with rheumatoid arthritis. Before disease-modifying antirheumatic drug therapy is implemented, an optimal basic program of physical therapy, rest, and nonsteroidal anti-inflammatory drugs should be implemented, and it must be documented that the patient still has sufficient disease to justify the costs, risks, and benefits of these treatments. Drugs that are approved by the Food and Drug Administration (FDA) are preferred over nonapproved drugs. Hydroxychloroquine, parenteral gold salts, oral gold, D-penicillamine, and the cytotoxic drug azathioprine are the FDA-approved disease-modifying antirheumatic drugs for use in rheumatoid arthritis. Many, not all, rheumatologists would employ hydroxychloroquine as the first-choice disease-modifying antirheumatic drug in patients who have early, mild, and nonerosive disease; treatment should be continued for six months before being abandoned for lack of efficacy, and appropriate ophthalmologic examination every four to six months is indicated. An alternative would be auranofin, whose efficacy approaches that of parenteral gold, yet may be safer. For patients who have severe active rheumatoid arthritis, especially with erosive changes, parenteral gold salts are usually a first choice. D-penicillamine is also effective in controlling the signs and symptoms of rheumatoid arthritis, but serious toxicity may occur. Azathioprine might be considered a competitor to D-penicillamine, although the FDA approval restricts its use to patients who have failed gold therapy. Two cytotoxic drugs that are not FDA approved are methotrexate and cyclophosphamide. Methotrexate can be very effective, but its side effects, particularly pulmonary and hepatic, must be carefully monitored. Cyclophosphamide is generally considered too toxic for use in patients with rheumatoid arthritis, although it may be helpful in patients with systemic rheumatoid vasculitis or patients who have failed all other therapies.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Role of disease-modifying antirheumatic drugs versus cytotoxic agents in the therapy of rheumatoid arthritis. 305 55

Forty patients with rheumatoid arthritis (RA) were enrolled in a double blind study of 26 weeks duration designed to compare the efficacy and safety of parenteral methotrexate and sodium aurothiomalate (GSTM) in the treatment of RA. All the patients had active RA and none had previously received gold, D-penicillamine or immunosuppressive therapy. Patients were randomized to receive weekly intramuscular (IM) injections of either methotrexate 10 mg or GSTM 50 mg. Two patients taking methotrexate and 7 taking GSTM were withdrawn before 26 weeks. Methotrexate was as effective as GSTM as measured by numbers of swollen or tender joints, morning stiffness, grip strength, pain scale and erythrocyte sedimentation rate. Five patients taking methotrexate and 11 taking GSTM presented side effects (p = 0.05). Total number of adverse reactions was 5 for the methotrexate group and 15 for the GSTM group (p less than 0.01). Our data suggest that low dose IM methotrexate is less toxic and as effective as GSTM for the treatment of RA during the first 6 months of therapy.
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PMID:A randomized controlled trial of parenteral methotrexate compared with sodium aurothiomalate (Myochrysine) in the treatment of rheumatoid arthritis. 313 77

Methotrexate, 7.5-25.0 mg, was taken in a single weekly dose by 101 patients with chronic rheumatoid arthritis. In the course of treatment there was significant improvement in pain and mobility, as well as in the number of inflamed joints, strength of hand-grip (both hands), and use of steroids. There was a significant fall in erythrocyte sedimentation rate, and haemoglobin content rose significantly. Improvement occurred in 85% of patients; within this group 30% had a remission during treatment. There were 7% non-responders. Side effects were frequent: gastrointestinal symptoms in about 50%, loss of hair and stomatitis in 10-20%. In nine patients methotrexate had to be discontinued because of side effects, but in six of them the drug was taken again later on. Transaminases increased in 50% of patients. No clear-cut histological changes were found in the liver. It is concluded that low-dose methotrexate is effective in the long-term treatment of chronic rheumatoid arthritis.
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PMID:[Treatment of chronic polyarthritis with low-dose methotrexate]. 337 Dec 11

A 22-year-old man was admitted to Kyushu University Hospital because of high fever, and pain in the right foot and back. An X-ray examination revealed an osteolytic lesion on the 5th metatarsal bone of the right foot. Paraplegia and disturbance of bladder function occurred and compression of the spinal cord between T3 and L5 was found by myelography. An extradural tumor was removed by emergent laminectomy, and a histological examination of the tumor showed aggregations of small round cells, which suggested Ewing's sarcoma. Although T-9 protocol was started with initial effect, the tumor recurred during the therapy. The patient was then treated with HD-MTX, ACR and VDS, which induced a clinical improvement for 4 months without maintenance therapy. This result showed that HD-MTX, ACR and VDS warrant further consideration for the treatment of refractory Ewing's sarcoma.
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PMID:[A case of Ewing's sarcoma treated successfully by combination chemotherapy consisting of high-dose methotrexate, aclacinomycin-A and vindesine]. 347 2

In this clinical trial of men with advanced prostatic cancer no longer responsive to hormone therapy 189 were randomized to receive estramustine phosphate, methotrexate or cis-platinum. Response evaluations were done in 158 cases. Objective response rates (complete, partial or stabilization of disease) were 34 per cent for estramustine phosphate, 36 per cent for cis-platinum and 41 per cent for methotrexate. Subjective parameters indicated a substantial advantage for pain improvement with methotrexate or cis-platinum over estramustine phosphate. Probabilities of continued response indicated some advantage for methotrexate and median response durations at this time were twice as long for methotrexate (32 weeks) as for cis-platinum (16 weeks), with estramustine phosphate intermediate (23 weeks). Survival rates for the original treatment randomization groups were not different at this time. Side effects of estramustine phosphate consisted primarily of nausea and vomiting and/or anorexia but to a lesser extent than with cis-platinum. These effects were somewhat less for methotrexate, for which the major side effects were stomatitis and leukopenia, as well as hepatic toxicity reflected by elevated serum glutamic oxaloacetic transaminase levels. Other side effects of cis-platinum were less than for methotrexate (no stomatitis), except for signs of renal toxicity (elevations in blood urea nitrogen and serum creatinine), which were greater. Methotrexate had a relatively high level of activity against metastatic, progressive, hormone nonresponsive prostatic cancer, with side effects that were substantial but manageable.
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PMID:Comparison of estramustine phosphate, methotrexate and cis-platinum in patients with advanced, hormone refractory prostate cancer. 634 29

Methotrexate osteopathy is an uncommon complication of long-term oral maintenance therapy for childhood neoplasms, most commonly acute lymphocytic leukemia. It is characterized by severe lower extremity pain and by osteoporosis particularly involving the lower extremities and thick dense provisional zones of calcification and growth arrest lines resembling scurvy. Fractures may occur. The appearance must be distinguished from recurrent or metastatic disease.
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PMID:Methotrexate osteopathy. 642 36

During intrathecal methotrexate therapy of meningeal manifestations of acute lymphatic leukemia, renewed occurrence of lymphoblasts in the cerebrospinal fluid cell picture developed in two women. Prompt clearance could be attained by application of cytosine arabinoside. Methotrexate-resistance as one reason is discussed. The value of differentiated cerebrospinal fluid cell investigations for diagnosis and treatment of meningeal leukemia is pointed out. Neuralgic pain syndrome due to neoplastic neuropathy by direct infiltration of peripheral nerves are discussed, therapeutic measures pointed out.
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PMID:[Methotrexate resistance in acute lymphatic leukemia treated intrathecally]. 693 33


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