Simonini G, Giani T, Stagi S, de Martino M, Falcini F
Department of Pediatrics-Rheumatology Unit, Via Pico della Mirandola 24, 50132 Florence, Italy.
Rheumatology (Oxford). 2005 Jun;44(6):777-80. doi: 10.1093/rheumatology/keh592. Epub 2005 Mar 1.
To evaluate bone mineral status over 1 yr of etanercept treatment in juvenile idiopathic arthritis (JIA).
Twenty children (13 female, 7 male) aged 5.2-11.4 yr, with active polyarticular JIA were prospectively enrolled to receive etanercept (0.4 mg/kg, twice weekly). Responders were defined according to the American College of Rheumatology Pediatric 50 definition of improvement. Broadband ultrasound attenuation (BUA) by bone was determined at the left calcaneus to assess bone status at baseline and at 1-yr follow-up.
After 12 months of treatment, 15 (75%) patients were considered as responders. At baseline, responders and non-responders did not differ with regard to age, disease duration, core-set variables or BUA and Z-score values (patient's value--age specific normal value/normal group's s.d.). At 6-month and 1-yr follow-up in the whole group, BUA and Z-score values were not significantly different compared with baseline. At 1-yr follow-up, but not at 6 months, all 15 responders, differently from non-responders, showed a significant increase in both BUA and Z-score values: BUA at 1 yr 55.2 +/- 3.3 vs baseline 43.5 +/- 3.2 dB/MHz, P<0.001; Z score at 1 yr -0.3 +/- 0.2 vs baseline 1.5 +/- 0.4, P<0.002.
For the first time in childhood rheumatic disease this pilot prospective study, although in a small group, shows evidence that 1 yr of etanercept therapy by controlling the underlying disease activity induces a sustained benefit on JIA bone loss. Prospective studies in larger patient samples are needed to confirm these data.
评估依那西普治疗幼年特发性关节炎（JIA）1年期间的骨矿物质状况。
前瞻性纳入20名年龄在5.2 - 11.4岁、患有活动性多关节型JIA的儿童（13名女性，7名男性），接受依那西普治疗（0.4mg/kg，每周两次）。根据美国风湿病学会儿科50%改善定义来确定反应者。通过测定左侧跟骨的骨宽带超声衰减（BUA）来评估基线和1年随访时的骨状况。
治疗12个月后，15名（75%）患者被视为反应者。基线时，反应者和非反应者在年龄、病程、核心指标变量或BUA及Z评分值（患者值 - 年龄特异性正常值/正常组标准差）方面无差异。在整个组的6个月和1年随访时，与基线相比，BUA和Z评分值无显著差异。在1年随访时（而非6个月时），所有15名反应者与非反应者不同，其BUA和Z评分值均显著增加：1年时BUA为55.2±3.3dB/MHz，而基线时为43.5±3.2dB/MHz，P<0.001；1年时Z评分为 -0.3±0.2，而基线时为1.5±0.4，P<0.002。
在儿童风湿性疾病中，这项初步前瞻性研究首次表明，尽管样本量小，但有证据显示依那西普治疗1年通过控制潜在疾病活动对JIA骨质流失产生持续益处。需要在更大患者样本中进行前瞻性研究以证实这些数据。
