Schmeling H, Mathony K, John V, Keysser G, Burdach S, Horneff G
Department of Paediatrics, Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany.
Ann Rheum Dis. 2001 Apr;60(4):410-2. doi: 10.1136/ard.60.4.410.
To study the efficacy of combination therapy with etanercept and methotrexate in patients with refractory juvenile idiopathic arthritis.
Seven children with active juvenile idiopathic arthritis refractory to at least combination therapy with methotrexate and sulfasalazine or cyclosporin A were studied. Concomitant treatment, consisting of non-steroidal drugs, corticosteroids, and methotrexate, remained unchanged.
Six patients continued the treatment for at least 24 weeks. In the child with systemic arthritis, etanercept was stopped because of persisting spiking fever, joint pain, and rash. In the remaining children an immediate significant decrease in joint pain (p<0.05), disappearance of morning stiffness, and regression of joint swelling (p<0.05) were observed. Improvement was apparent after two injections. An immediate significant (p<0.05) decrease in erythrocyte sedimentation rate, C reactive protein, and interleukin 6 was observed. Side effects consisted of mild reactions at the injection site in two children.
In this observational study, etanercept in combination with methotrexate was well tolerated and highly effective in treating juvenile polyarthritis but not in the patient with systemic arthritis. Combination treatment appears to be feasible in terms of toxicity and may enhance efficiency.
研究依那西普与甲氨蝶呤联合治疗难治性幼年特发性关节炎患者的疗效。
对7例患有活动性幼年特发性关节炎且至少对甲氨蝶呤与柳氮磺胺吡啶或环孢素A联合治疗无效的儿童进行研究。由非甾体类药物、皮质类固醇和甲氨蝶呤组成的联合治疗保持不变。
6例患者持续治疗至少24周。在患有全身型关节炎的儿童中，由于持续出现高热、关节疼痛和皮疹，停用了依那西普。在其余儿童中，观察到关节疼痛立即显著减轻（p<0.05）、晨僵消失以及关节肿胀消退（p<0.05）。两次注射后改善明显。观察到红细胞沉降率、C反应蛋白和白细胞介素6立即显著降低（p<0.05）。副作用包括两名儿童注射部位出现轻度反应。
在这项观察性研究中，依那西普与甲氨蝶呤联合使用耐受性良好，对治疗幼年多关节炎非常有效，但对全身型关节炎患者无效。联合治疗在毒性方面似乎是可行的，并且可能提高疗效。
