来氟米特治疗多关节炎型幼年特发性关节炎疗效观察
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摘要
目的探讨来氟米特在治疗多关节炎型幼年特发性关节炎(JIA)中的有效性和安全性。方法 54例多关节炎型JIA患儿,均给予来氟米特口服治疗。观察患儿关节影像学检查结果、病情活动指标水平变化情况、临床转归、安全性以及随访结果。结果 54例患儿中,骨关节破坏7例(12.96%)。患儿治疗1个月血红细胞沉降率增快、C反应蛋白增高、外周血白细胞增高比例与治疗前比较,差异无统计学意义(P>0.05);治疗3个月血红细胞沉降率增快、C反应蛋白增高、外周血白细胞增高比例均低于治疗前、治疗1个月,差异均有统计学意义(P<0.05);治疗前、治疗1个月、治疗3个月类风湿因子比例比较,差异均无统计学意义(P>0.05)。患儿治疗3个月美国风湿病学会(ACR)儿科30、50、70标准缓解率分别为92.6%、63.0%、40.7%,均高于治疗1个月的27.8%、14.8%、3.7%,差异均有统计学意义(P<0.05)。患儿不良反应发生率为18.5%(10/54)。对54例患儿进行门诊、电话随访,每2～4周随访1次,共随访12～18个月,无失访病例。其中, 1例患儿于治疗5个月后自行停药,停药2个月后病情再次活动,再次加用来氟米特治疗1个月后病情好转。其余患儿均病情稳定。结论来氟米特治疗多关节炎型JIA患儿3个月后逐渐显效,近期效果明显,耐受性较好。
Objective To discuss the effectiveness and safety of leflunomide on the treatment of polyarthritis juvenile idiopathic arthritis(JIA). Methods A total of 54 polyarthritis JIA children all received oral administration of leflunomide. The results of joint imaging examination, changes of disease activity index level, clinical outcome, safety and follow-up results were observed. Results Among 54 cases, 7 cases(12.96%) had bone and joint destruction. There was no significant difference in proportion of increased erythrocyte sedimentation rate, elevated C-reactive protein and elevated peripheral white blood cells between the two groups before and after 1 month of treatment(P>0.05). The proportion of increased erythrocyte sedimentation rate, elevated C-reactive protein and elevated peripheral white blood cells after 3 months of treatment was lower than those before treatment and 1 month after treatment. Their difference was statistically significant(P<0.05). There was no significant difference in the proportion of rheumatoid factors before treatment, 1 month after treatment and 3 months after treatment(P>0.05). The standard remission rates of 30, 50 and 70 in pediatrics of the American College of Rheumatology(ACR) were 92.6%, 63.0% and 40.7% respectively after 3 months of treatment, which were higher than those of 27.8%, 14.8% and 3.7% after 1 month of treatment(P<0.05). The incidence of adverse reactions was 18.5%(10/54). 54 children were followed up by telephone and outpatient clinics every 2～4 weeks for 12～18 months, and no cases were lost. Among them, 1 patient discontinued the drug after 5 months of treatment, and the disease reactivated after 2 months of withdrawal. After 1 month of treatment with flumetide, the condition improved. The rest of the children were in stable condition. Conclusion Leflunomide is effective in the treatment of polyarthritis JIA 3 months later, with obvious short-term effect and good tolerance.
Objective To discuss the effectiveness and safety of leflunomide on the treatment of polyarthritis juvenile idiopathic arthritis(JIA). Methods A total of 54 polyarthritis JIA children all received oral administration of leflunomide. The results of joint imaging examination, changes of disease activity index level, clinical outcome, safety and follow-up results were observed. Results Among 54 cases, 7 cases(12.96%) had bone and joint destruction. There was no significant difference in proportion of increased erythrocyte sedimentation rate, elevated C-reactive protein and elevated peripheral white blood cells between the two groups before and after 1 month of treatment(P>0.05). The proportion of increased erythrocyte sedimentation rate, elevated C-reactive protein and elevated peripheral white blood cells after 3 months of treatment was lower than those before treatment and 1 month after treatment. Their difference was statistically significant(P<0.05). There was no significant difference in the proportion of rheumatoid factors before treatment, 1 month after treatment and 3 months after treatment(P>0.05). The standard remission rates of 30, 50 and 70 in pediatrics of the American College of Rheumatology(ACR) were 92.6%, 63.0% and 40.7% respectively after 3 months of treatment, which were higher than those of 27.8%, 14.8% and 3.7% after 1 month of treatment(P<0.05). The incidence of adverse reactions was 18.5%(10/54). 54 children were followed up by telephone and outpatient clinics every 2～4 weeks for 12～18 months, and no cases were lost. Among them, 1 patient discontinued the drug after 5 months of treatment, and the disease reactivated after 2 months of withdrawal. After 1 month of treatment with flumetide, the condition improved. The rest of the children were in stable condition. Conclusion Leflunomide is effective in the treatment of polyarthritis JIA 3 months later, with obvious short-term effect and good tolerance.
引文
[1]Takeishi M, Akiyama Y, Akiba H, et al. Leflunomide induced acute interstitial pneumonia. Journal of Rheumatology, 2005, 32(6):1160-1163.
[2]Rodriguez-Rodriguez L, Jover-Jover J, Fontsere O, et al. Leflunomide discontinuation in rheumatoid arthritis and influence of associated disease-modifying anti-rheumatic drugs:a survival analysis.Scandinavian Journal of Rheumatology, 2013, 42(6):433-436.
[3]Petty RE, Southwood TR, Manners P, et al. International league of associations for rheumatology classification of juvenile idiopathic arthritis:second revision, Edmonton, 2001. Journal of Rheumatology,2004, 31(2):390-392.
[4]Giannini EH, Ruperto N, Ravelli A, et al. Preliminary definition of improvement in juvenile arthritis. Arthritis Rheum, 2010,40(7):1202-1209.
[5]Fife MS, Gathercole L, Ogilvie EM, et al. No evidence for genetic association of interferon regulatory factor 1 in juvenile idiopathic arthritis. Arthritis&Rheumatism, 2007, 56(3):972-976.
[6]Palmisani E, Solari N, Magnimanzoni S, et al. Correlation between juvenile idiopathic arthritis activity and damage measures in early,advanced, and longstanding disease. Arthritis Care&Research,2006, 55(6):843-849.
[7]Meier FM, Frerix M, Hermann W, et al. Current immunotherapy in rheumatoid arthritis. Immunotherapy, 2013, 5(9):955-974.
[8]Woo, P. Systemic juvenile idiopathic arthritis:diagnosis, management,and outcome. Nat Clin Pract Rheumatol, 2006, 2(1):28-34.
[9]Ostlie IL, Dale O, Moller A. From childhood to adult life with juvenile idiopathic arthritis(JIA):a pilot study. Disability&Rehabilitation, 2007, 29(6):445-452.
[2]Rodriguez-Rodriguez L, Jover-Jover J, Fontsere O, et al. Leflunomide discontinuation in rheumatoid arthritis and influence of associated disease-modifying anti-rheumatic drugs:a survival analysis.Scandinavian Journal of Rheumatology, 2013, 42(6):433-436.
[3]Petty RE, Southwood TR, Manners P, et al. International league of associations for rheumatology classification of juvenile idiopathic arthritis:second revision, Edmonton, 2001. Journal of Rheumatology,2004, 31(2):390-392.
[4]Giannini EH, Ruperto N, Ravelli A, et al. Preliminary definition of improvement in juvenile arthritis. Arthritis Rheum, 2010,40(7):1202-1209.
[5]Fife MS, Gathercole L, Ogilvie EM, et al. No evidence for genetic association of interferon regulatory factor 1 in juvenile idiopathic arthritis. Arthritis&Rheumatism, 2007, 56(3):972-976.
[6]Palmisani E, Solari N, Magnimanzoni S, et al. Correlation between juvenile idiopathic arthritis activity and damage measures in early,advanced, and longstanding disease. Arthritis Care&Research,2006, 55(6):843-849.
[7]Meier FM, Frerix M, Hermann W, et al. Current immunotherapy in rheumatoid arthritis. Immunotherapy, 2013, 5(9):955-974.
[8]Woo, P. Systemic juvenile idiopathic arthritis:diagnosis, management,and outcome. Nat Clin Pract Rheumatol, 2006, 2(1):28-34.
[9]Ostlie IL, Dale O, Moller A. From childhood to adult life with juvenile idiopathic arthritis(JIA):a pilot study. Disability&Rehabilitation, 2007, 29(6):445-452.