***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the potential benefits of methotrexate in patients with systemic lupus erythematosus ( SLE ) . METHODS A 12-month , double-blind , placebo-controlled trial of methotrexate with folic acid was conducted . Intent-to-treat analyses were performed with mixed linear models and alpha = 0.04 ( 96 % confidence interval [ 96 % CI ] ) to account for interim analysis of longitudinal data to assess the treatment effects on lupus disease activity and daily steroid dose across monthly measurements , and to test if the treatment effects depended on selected participant characteristics . RESULTS Of 215 participants screened , 94 were excluded , 35 declined , and 86 were r and omized ( methotrexate = 41 , placebo = 45 ) . The groups were balanced for demographic and disease characteristics . Antimalarial use was more frequent in the placebo group , which was adjusted for in multivariable analyses . Sixty participants ( 27 methotrexate , 33 placebo ) completed the study and 26 terminated early . Among participants who had the same baseline prednisone dose , those taking methotrexate received , on average , 1.33 mg/day less prednisone during the trial period ( 96 % CI 0.06 , 2.72 mg/day ; a 22 % reduction of their average-during-trial daily dose ) compared with those in the placebo group . For the primary measure of disease activity ( revised Systemic Lupus Activity Measure ) , methotrexate use was also associated with a marginally significant reduction in the mean during-trial score of 0.86 units ( 96 % CI 0.01 , 1.71 ; P = 0.039 ) . A significant interaction between treatment and baseline damage was found ( P = 0.001 ) . CONCLUSION Methotrexate conferred a significant advantage in participants with moderately active lupus by lowering daily prednisone dose and slightly decreasing lupus disease activity . As a therapeutic option in moderate SLE , methotrexate can be considered to be steroid sparing OBJECTIVE To determine the efficacy and tolerability of low dose intermittent methotrexate ( MTX ) in antimalarial resistant lupus arthritis . METHODS Retrospective cohort study from the University of Toronto Lupus Clinic . Seventeen patients receiving MTX for persistently active arthritis , despite a previous therapeutic trial of antimalarial therapy , were identified . Seventeen control patients were selected who had active arthritis despite 6 months of treatment with an antimalarial agent . The primary outcome measure was a reduction in actively inflamed joint count of at least 60 % over 6 months . Secondary outcome measures were the reduction in steroid dose and Systemic Lupus Erythematosus Disease Activity Index ( SLEDAI ) , and tolerability of MTX .  RESULTS Baseline characteristics including sex , race , age at diagnosis , and concomitant use of other medications were similar . Patients in the MTX group had a higher mean joint count than the control group at baseline ( p = 0.003 ) . After 6 months , 15/17 patients in the MTX group showed at least a 60 % improvement in the joint count compared to only 2/17 for the control group ( p < 0.001 ) . The mean daily prednisone dose fell by 35 and 27 % in the MTX and control groups , respectively ( p = NS ) . A mean SLEDAI reduction of 0.76 was obtained in the MTX group , compared to an increase of 2.05 in the control group ( p = 0.03 ) . Over a mean followup period of 3.5 years , toxicity leading to termination was infrequent , as only 2 patients discontinued MTX due to a side effect . CONCLUSION Methotrexate appears to be effective in the treatment of antimalarial resistant lupus arthritis and is well tolerated OBJECTIVE To evaluate the capacity of methotrexate ( MTX ) to control mild activity of  systemic lupus erythematosus ( SLE ) , and to evaluate the capacity of MTX to reduce steroid requirement , as well as to evaluate the side effects of MTX in patients with SLE . METHODS A prospect i ve , r and omized , controlled , double blind trial . Forty-one patients with SLE began and 37 completed the 6 months of study . The mean disease duration was 82.5 months . Twenty patients received MTX 15 - 20 mg/week ( MTX group ) and 21 received placebo ( PL group ) . The dose of prednisone was maintained , increased , or reduced after the first month , according to monthly clinical and laboratory evaluation . Dose of prednisone , SLE Disease Activity Index ( SLEDAI ) scores , the score by visual analog scale ( VAS ) for articular pain , and laboratory results were recorded monthly . Both groups were homogeneous and comparable for clinical manifestations and laboratory results . RESULTS Two placebo patients dropped out due to severe flare of disease requiring hospitalization , and 2 patients taking MTX dropped out due to side effects ( one with pulmonary tuberculosis , one with urticaria and severe dyspepsia ) . Thirty-seven patients ( 18 MTX and 19 PL ) completed the study . At the end of the study 16 PL patients and one MTX patient presented articular complaints ( p < 0.001 ) . VAS scores for pain were significantly higher in the PL group than in the MTX group after the first month of study . Sixteen PL patients and 3 MTX patients presented cutaneous lesions after 6 months of treatment ( p < 0.001 ) . At the end of the study 4 MTX patients and 11 PL patients presented hypocomplementemia ( p < 0.001 ) . Mean SLEDAI scores in PL patients were significantly higher than in MTX patients at Months 3 , 4 , 5 , and 6 . It was possible to decrease the prednisone dose for 13 MTX patients during the study but for only one PL patient ( p < 0.001 ) . Fourteen MTX patients ( 70 % ) presented side effects , mainly dyspepsia and increase in hepatic enzyme serum levels , and 3 PL patients ( 14 % ) presented dyspepsia . CONCLUSION MTX 15 to 20 mg/week for 6 months was effective in controlling cutaneous and articular activity of SLE and permitted prednisone dose reduction . At these doses MTX presented frequent but mild side effects that did not result in drug discontinuation in the majority of patients New clinical scales for semiquantitating disease activity in systemic lupus erythematosus ( SLE ) are widely used in research . They are reliable and valid measures . One of the original scales , the  Systemic Lupus Activity Measure  ( SLAM ) , has been modified based on experience with it in multiobserver studies and training of individuals in its use . We tested the psychometric properties of the revised SLAM ( SLAM-R ) . SLAM-R was tested on 30 SLE patients , who fulfilled 1997 revised ACR criteria and were selected to represent a range of disease activity . The patients were evaluated independently by  two physicians , who studied the instruction booklet and who had never used SLAM-R , on two occasions 2–4 weeks apart . At the first visit , the physician 's global assessment of activity using visual analog scale , anti-dsDNA Ab , C3 and C4  were checked for construct validity . The psychometric properties were analyzed with nested analysis of variance and Pearson 's correlation coefficient using SAS . All patients were female , the median age was 31 ( 15–52 ) y , and the mean score of SLAM-R was 10.5±5.3 ( 3–26 ) . Estimates of reliability were 0.78 of inter-rater , 0.61 of inter-visit , 0.76 of physician 1 between visits , and 0.56 of physician 2 between visits . Among subcategories except ‘ Eye , ’ the ‘ Gastrointestinal ’ category had the highest ( 0.96 ) and the ‘ Neuromotor ’ category had the lowest inter-rater reliability ( 0.50 ) . With respect to construct validity , the correlation of SLAM-R scores with the disease activity variables except C4 was high and statistically significant . In conclusion , the SLAM-R is reliable and valid for measuring clinical disease activity in SLE OBJECTIVE To determine the long-term efficacy and safety of low-dose methotrexate ( MTX ) in rheumatoid arthritis ( RA ) . METHODS Eighty-four-month open prospect i ve trial at a single academic rheumatology center . RESULTS Twenty-six patients were enrolled in a prospect i ve study of the long-term efficacy of MTX in RA ; a significant improvement had been demonstrated after 36 months of therapy . Twelve patients remained in the study at the 84-month visit ; the mean weekly dosage of MTX was 10.2 mg . A significant improvement was still noted at 84 months in the number of painful joints , number of swollen joints , joint pain index , joint swelling index , and physician and patient global assessment s. A 50 % improvement in the joint pain index and joint swelling index was observed in more than 80 % of the 12 patients still enrolled . A significant reduction in prednisone dosage was achieved ; of 14 patients taking prednisone at entry , 7 had discontinued prednisone completely . Fourteen patients withdrew from the study : 10 between 0 and 36 months , and 4 between 36 and 84 months .  Toxicity in 3 patients and visit noncompliance in 1 patient were the reasons for withdrawal between 36 and 84 months . At 84 months , 46 % of the patients remained in the study ; 11.5 % had discontinued due to MTX toxicity . CONCLUSION The effectiveness of MTX in the treatment of RA continues to be demonstrated in this prospect i ve study , after 84 months of treatment OBJECTIVE To examine the relationship between changes in anti-double-str and ed DNA ( anti-dsDNA ) antibody levels and the risk of renal flare in patients with systemic lupus erythematosus ( SLE ) , using data from 2 r and omized , controlled trials . METHODS Analyses were based on 487 patients with SLE and a history of lupus nephritis who had an anti-dsDNA antibody titer > /=15 IU/ml at baseline , as measured by Farr assay . Results are presented for the combined population of patients , the placebo arms , and the drug treatment arms in which a dsDNA-based bioconjugate ( abetimus sodium ; LJP 394 ) was used . RESULTS Changes in anti-dsDNA antibody levels were inversely correlated with changes in the C3 level ( P < 0.0001 in both trials ) . Cox proportional hazards regression models showed that changes in anti-dsDNA antibody levels correlated with the risk of renal flare . The models predicted that a point estimate of a 50 % reduction in anti-dsDNA antibody levels is associated with a 52 % reduction ( 95 % confidence interval [ 95 % CI ] 26 - 68 % , nominal P = 0.0007 ) and a 53 % reduction ( 95 % CI 33 - 69 % , nominal P < 0.0001 ) in the risk of renal flare in the 2 trials , respectively . In the 2 trials , the incidence of renal flare was lower in patients with sustained reductions in anti-dsDNA antibodies ( 3.0 % and 4.1 % , respectively ) than in patients with stable or increasing antibody levels ( 21.3 % and 20.3 % , respectively ) . CONCLUSION Changes in anti-dsDNA antibody levels were directly correlated with the risk of renal flare and inversely correlated with changes in the C3 level . Reducing anti-dsDNA antibody levels may represent a therapeutic objective in SLE patients with lupus nephritis , because it is associated with a reduced risk of renal flare Aim : A prospect i ve open‐label study comparing the efficacy and safety of methotrexate ( MTX ) and chloroquine ( CQ ) in articular and cutaneous manifestations of systemic lupus erythematosus ( SLE ) OBJECTIVES Methotrexate ( MTX ) has been used in several autoimmune diseases . Apart from its use in rheumatoid arthritis , MTX has been assessed in small studies in patients with vasculitis , uveitis , and inflammatory bowel disease . The aim of this study was to evaluate the efficacy of MTX in a particular group of patients with systemic lupus erythematosus ( SLE ) . PATIENTS In an open prospect i ve study 22 patients fulfilling the ACR criteria for SLE were included . Patients had one or more of the following manifestations : active non-destructive polyarthritis , dermatitis , vasculitis of the skin , pleuritis . All patients had been treated with corticosteroids for at least six months without achieving remission . Sixteen patients were taking antimalarial drugs in addition to corticosteroids  , which were stopped at the beginning of the trial . Patients with renal and central nervous involvement were excluded from the study . All patients received MTX orally at a dose of 15 mg/week over six months . Corticosteroids were continued . As additional medication only indomethacin up to 100 mg/day was permitted if used before the start of the study . The outcome was evaluated using the SLE disease activity index ( SLEDAI ) . RESULTS Disease activity was evaluated after six months of MTX treatment . All patients completed the study period . The SLEDAI decreased significantly from 
    Output:
    
Conclusion The use of MTX is associated with significant reductions in SLEDAI and the average dose of corticosteroids in adult patients with SLE