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Item Effect of subcutaneous high-dose methotrexate treatment on the management of rheumatoid arthritis(2021) Tufan, Muge Aydin; Ersozlu, Emine Duygu; Koseoglu, Hamide Kart; Yucel, Ahmet EftalPurpose: Methotrexate (MTX) is still the main treatment option for rheumatoid arthritis (RA). There is no consensus on drug administration routes and dosage when administered alone or in combination with other drugs. This study aims to identify the effects of early administration of a combination therapy containing high dose subcutaneous (SC) MTX on RA management. Materials and Methods: Forty-five patients with RA who newly diagnosed were divided into two groups randomly. The patients who took 12.5 mg SC MTX per week in the first 4 weeks defined as a "low dose group". The patients who took 25 mg SC MTX per week in the first 4 weeks defined as a "high dose group". Then, patients of both groups continued with 12.5 mg oral MTX per week. Clinical and laboratory findings, disease activity scores and response rates of the patients were recorded at the beginning, 3rd months and 6th months. Results: There was no significant difference between the two groups at 3rd month's values. There were statistically significant improvements at 6th month's values. Values were as follows in low and high dose groups: mean DAS28-CRP (3.5 vs 2.7), VAS pain score (3.3 vs 1.6), and TJC28 (3 vs 1.5), respectively. Conclusion: Early administration of high-dose SC MTX effectively controls disease activity and increases the quality of life in RA patients.Item The effectiveness of intra-articular bleomycin versus methotrexate in a chronic synovitis model(2020) Maralcan, Gokhan; Inan, Ulukan; Kuru, Ilhami; Aktepe, Fatma; Isik, Cengiz; 0000-0002-1268-1451; AAJ-4341-2021Objective: To compare the effectiveness of methotrexate which was proven to be effective for rheumatoid arthritis and bleomycin in a synovitis model. Our aim was to show whether bleomycin could be used for chemical synovectomy purposes. Design: Experimental study Setting: Department of Orthopedics and Traumatology, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey Subjects: Fifteen mature New Zealand rabbits were studied. Synovitis was induced by repeated injections of lambda carrageenan. Interventions: Knees of the subjects were grouped as sham, bleomycin and methotrexate. After synovitis occurred, sterile saline injected knees formed the sham group, bleomycin and methotrexate injected knees composed the study groups. In the 9th week of the study, animals were euthanised. Standard specimens were harvested from all knees. Immunoperoxidase staining was performed. Main outcome measures: The intensity of synovitis was evaluated with thickness of the synovial cell layers, intensity of inflammatory infiltrate and iNOS expression in cells. Results: Thickness of the synovial cell layers was greater in the sham group than in the study groups (p<0.05). Intensity of inflammatory infiltrate, lymphoplasmacytoid infiltrate, and histiocytes in the sham group were greater than in the study groups (p<0.05). iNOS expression in histocytes and plasma cells was significantly decreased in the study groups compared to sham operated group (p<0.05). There was no statistically significant difference between bleomycin and methotrexate groups with respect to synovial cell layer thickness and lymphoplasmacytoid infiltrate. Conclusions: According to these results, intraarticular bleomycin seems as effective as methotrexate in experimental synovitis model.