Weller F, Huppertz H-I
Prof.-Hess-Kinderklinik Zentrum für Kinderheilkunde und Jugendmedizin am Klinikum Bremen-Mitte, Sankt-Jürgen-Strasse 1, 28205 Bremen.
Z Rheumatol. 2005 Jun;64(5):308-16. doi: 10.1007/s00393-005-0750-4.
The treatment of juvenile idiopathic arthritis has changed a great deal in the last few years. Pharmacomedical treatment, physiotherapy and teaching the patients and parents are the mainstays of successful therapy. Using all available treatment options and thanks to new therapeutic options (TNFalpha-blockade) and due to a better understanding of the pathogenesis, individual therapeutic strategies provide adequate disease control in the large majority of cases. According to the subtype of juvenile idiopathic arthritis, different medications are used in combination with nonsteroidal antiinflammatory drugs (NSAID) which are used initially. Methotrexate (MTX) and steroids in various applications are the drugs of choice for the systemic and polyarticular courses; intraarticular steroids, sulfasalazine and hydroxychloroquine for the oligoarticular subtype. The new option of TNFalpha-blockade (Etanercept, Infliximab, Adalimumab) offers significant clinical benefit in patients with polyarticular involvement, who do not respond to MTX. Further biological agents (Anakinra, Abatacept, Atlizumab) are used in children and adolescents in clinical studies. Rarely azathioprine, cyclosporine A, leflunomide and cyclophosphamide are used. Stem cell transplantation has been tried as a very last resort but interpretation of the results is controversial. Due to the improvement of the therapeutic options, the approaches to the patients and their disease has changed and cautious optimism is justified.
在过去几年中，青少年特发性关节炎的治疗发生了很大变化。药物治疗、物理治疗以及对患者和家长的教育是成功治疗的主要支柱。运用所有可用的治疗选择，得益于新的治疗方法（肿瘤坏死因子α阻断）以及对发病机制的更好理解，个体化治疗策略在大多数情况下能实现对疾病的充分控制。根据青少年特发性关节炎的亚型，不同药物与最初使用的非甾体抗炎药（NSAID）联合使用。甲氨蝶呤（MTX）和各种应用中的类固醇是全身型和多关节型病程的首选药物；关节内注射类固醇、柳氮磺胺吡啶和羟氯喹用于少关节型亚型。肿瘤坏死因子α阻断的新方法（依那西普、英夫利昔单抗、阿达木单抗）在多关节受累且对MTX无反应的患者中具有显著的临床益处。其他生物制剂（阿那白滞素、阿巴西普、阿特珠单抗）正在儿童和青少年中进行临床研究。很少使用硫唑嘌呤、环孢素A、来氟米特和环磷酰胺。干细胞移植作为最后的手段进行了尝试，但结果的解释存在争议。由于治疗选择的改善，对患者及其疾病的治疗方法已经改变，谨慎的乐观态度是合理的。
