Correlation between PASI and Histopathologic Score in the Assessment of Methotrexate Efficacy in Psoriasis

Background and Design: Twenty-one patients with severe plaque psoriasis treated with methotrexate were included in this study. One of our aims was to determine the correlation between clinical efficacy and histopathologic changes. The other one was to determine the value of histopathologic evaluation in the decision of treatment and follow-up periods. Materials and Methods: Methotrexate was given intramuscularly, as 15 mg at the beginning, than 25 mg in a
single dose weekly. PASI and histopathologic evaluation were performed before treatment, at the end of 1st and 3rd months. Histopathologic evaluation has been performed for histopathologic score.
Results: At the end of the third month, pretreatment PASI score and histopathologic score decreased % 93 and % 49.2, respectively. Histopathologic improvement was correlated with clinical improvement but not as good as latter. Relapse of the disease was observed in 13 patients after 4 months. In conclusion, when making the decision of therapy cessation, we should not only rely on clinical assessment, but also histopathologic evaluation. For this purpose development of histopathologic score may be beneficial in the determination of treatment period.

Psoriasiste metotreksat etkinliðinin deðerlendirilmesinde pasi-histopatolojik skor iliþkisi

Metotreksat tedavisi alan plak tip þiddetli psoriasis vulgarisli 21 hasta çalýþmaya alýndý. Amaçlarýmýzdan biri, psoriasisli hastalarda metotreksatýn klinik etkinliðinin histopatolojik bulgular ile korelasyonunu tespit etmekti. Diðer amacýmýz ise, histopatolojik deðerlendirmenin, tedavi ve takip sürelerinin belirlenmesindeki önemini saptamaktý. Metotreksat baþlangýçta haftalýk tek doz 15 mg, sonraki haftalarda 25 mg dozda intramusküler olarak uygulandý. Histopatolojik tetkik ve PASI deðerlendirmesi tedavi öncesi, 1. ve 3.ay sonunda yapýldý. Histopatolojik deðerlendirme geliþtirilen histopatolojik skor ile yapýldý. Tedavi öncesi PASI deðeri, 3.ay sonunda % 93, tedavi öncesi histopatolojik skor, 3.ay sonunda % 49.2 oranýnda azaldý. Histopatolojik iyileþme klinik iyileþme ile korelasyon göstermekle birlikte klinik iyileþme kadar iyi deðildi. Kontrole gelen hastalarýn 13'ünde ortalama 4 ay sonra lezyonlarda relaps görüldü. Sonuç olarak tedavinin kesilmesine karar verilirken sadece klinik iyileþmeye bakýlmamasý, ayný zamanda histopatolojik kontrolün de yapýlmasý gereklidir. Bu amaçla geliþtirilecek bir histopatolojik skorun kullanýlmasýnýn tedavi süresinin belirlenmesinde faydalý olacaðý kanýsýndayýz.