Intrathecal injection with methotrexate plus dexamethasone in the treatment of central nervous system involvement in systemic lupus erythematosus.

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).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.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.I.t. with MTX plus DXM is a promising method for treating CNS lupus and deserves further investigation.