Objective: To investigate the effect of intrathecal injection (i.t.) with methotrexate (MTX) plus dexamethasone (DXM) in treating central nervous system involvement in systemic lupus erythematosus (CNS lupus).
Methods: Twenty-four CNS lupus patients that were refractory to conventional steroid therapy were selected for i.t. with MTX 10-20 mg plus DXM 10-20 mg. The effects and side effects of i.t. were closely observed.
Results: The symptoms and signs of 22/24 (91.7%) CNS lupus patients receiving i.t. improved considerably. Cerebrospinal fluid pressure, protein and WBC levels declined from 201.5 +/- 155.4 mm H2O, 145.2 +/- 87.6 mg/dl and 25.1 +/- 14.3/mm3 to 128.7 +/- 108.1 mm H2O, 60.8 +/- 38.3 mg/dl and 6.8 +/- 2.1/mm3 respectively. Transient side effects were observed in 4 patients: 1 with itching sensation of lower limbs, 2 with headache and 1 with incontinence.
Conclusion: I.t. with MTX plus DXM is a promising method for treating CNS lupus and deserves further investigation.