The treatment of disseminated vasculitis with methotrexate

With the great interest in recent years in the use of immunosuppressive/antiinflammatory drugs for the treatment of severe systemic inflammatory disorders, it is surprising that, except in Wegener's granulomatosis, the use of methotrexate (MTX) in disseminated vasculitides has been neglected. We have treated three patients with MTX, each with a different form of severe, corticosteroid-resistant, life-threatening, disseminated vasculitis. One had a nonspecific vasculitis characterized by excruciating muscle pain, weakness, and atrophy; the second had rheumatoid vasculitis with extensive skin ulceration and four-limb mononeuritis multiplex; the third had polyarteritis nodosa with hypertension, eventually fatal renal disease, and severe peripheral neuropathy. Treatment in each case was associated with a dramatic, favorable change in a course previously marked by relentless deterioration; two patients are alive 4 and 5 years later, without MTX. The purpose of this preliminary report is to indicate the possible efficacy of MTX in a wider group of disorders than those to which it is generally limited at present, and to stimulate its further evaluation.