Foell D, Frosch M, Schulze zur Wiesch A, Vogl T, Sorg C, Roth J
Department of Paediatrics, University of Muenster, Albert-Schweitzer-Str 33, D-48149 Muenster, Germany.
Ann Rheum Dis. 2004 Feb;63(2):206-8. doi: 10.1136/ard.2003.005686.
To investigate whether prolonged methotrexate (MTX) treatment after induction of remission influences the subsequent duration of remission in patients with juvenile idiopathic arthritis (JIA), and to analyse the usefulness of myeloid related proteins 8 and 14 (MRP8/MRP14) as predictive markers for the stability of remission at the time when MTX is withdrawn.
Twenty five patients with oligoarticular and polyarticular JIA who received MTX to induce remission were followed up. MTX treatment was stopped after a mean of 3.8 months (group 1) or 12.6 months (group 2) after remission was documented. Differences in the number of relapses between these groups were looked for. Additionally, MRP8/MRP14 were analysed by ELISA in 22 patients.
No difference was found in the number of relapses between patients with prolonged or early discontinued MTX treatment. Patients who were in stable remission had significantly lower MRP levels when MTX was discontinued than patients with relapses. With a cut off point for MRP8/MRP14 at 250 ng/ml, sensitivity and specificity were 100% and 70%, respectively.
Longer duration of MTX treatment after induction of remission does not generally improve the status of remission in patients with JIA. Residual synovial inflammation seems to influence the rate of relapses after discontinuation of MTX treatment. MRP8/MRP14 indicate residual activity even in the absence of other laboratory or clinical signs of continuing inflammation. Normal serum concentrations of MRP8/MRP14 in clinical inactive arthritis may help to identify patients in whom MTX can be safely withdrawn after remission is achieved.
探讨青少年特发性关节炎（JIA）患者诱导缓解后延长甲氨蝶呤（MTX）治疗是否会影响随后的缓解持续时间，并分析髓样相关蛋白8和14（MRP8/MRP14）作为MTX停用之时缓解稳定性预测标志物的有效性。
对25例接受MTX诱导缓解的少关节型和多关节型JIA患者进行随访。在记录到缓解后，分别于平均3.8个月（第1组）或12.6个月（第2组）后停止MTX治疗。观察两组间复发次数的差异。此外，对22例患者采用酶联免疫吸附测定法（ELISA）分析MRP8/MRP14。
MTX治疗延长或早期停用的患者之间复发次数无差异。MTX停用之时，处于稳定缓解的患者MRP水平显著低于复发患者。以MRP8/MRP14的截断值为250 ng/ml时，敏感性和特异性分别为100%和70%。
诱导缓解后延长MTX治疗时间一般不会改善JIA患者的缓解状态。残留的滑膜炎症似乎会影响MTX治疗停药后的复发率。即使在没有其他持续炎症的实验室或临床体征时，MRP8/MRP14也表明存在残留活性。临床无活动的关节炎患者血清MRP8/MRP14浓度正常可能有助于识别在达到缓解后可安全停用MTX的患者。
