Brunner H I, Kim K N, Ballinger S H, Bowyer S L, Griffin T A, Higgins G C, Mier R, Passo M H, Rennebohm R, Schikler K, Lovell D J
Children's Hospital Medical Center Cincinnati, Ohio 45229, USA.
J Clin Rheumatol. 2001 Oct;7(5):295-300. doi: 10.1097/00124743-200110000-00008.
The documentation of treatments used for Juvenile Rheumatoid Arthritis (JRA) is important to allow for the evaluation of practice patterns for future outcome studies. A survey of nine pediatric rheumatologists was performed between September 1999 and February 2000. Each of the physicians prospectively recorded demographic and treatment information on consecutively sampled JRA patients (n=395). Pauciarticular onset JRA was present in 46%, polyarticular onset JRA in 35%, and systemic onset JRA in 19% of the children. Naproxen was the most frequently prescribed medication (55% of the patients), followed by methotrexate (MTX), which was used in 39% of the patients. Folic acid supplementation (1 mg/day) was provided to 69% of the patients treated with MTX. Etanercept was used in 11% of the children. Eleven percent of the patients received corticosteroids, and 13% of children on corticosteroids took calcium supplements. Uveitis was present in 8% and had a chronic course in 79% of those cases. Although systemic medications were used in 50% of the children with uveitis to control eye inflammation, severe damage to the eyes developed in 30% of them. Fourteen percent of the patients required gastroprotective medications. Compared with findings of a similar survey performed in 1993, there was no significant change in the frequency of use of naproxen, but nabumetone is now more often prescribed, and COX-2 inhibitors have been introduced in the therapy of JRA. Changes among second-line agents used for JRA have also occurred, although there was no change in the frequency of use of MTX or corticosteroids. JRA continues to be a treatment challenge for the practicing pediatric rheumatologist. Patients often show incomplete response to the currently available medications. Therefore, new therapeutic agents need to be evaluated for their use in JRA, and the treatment of JRA associated uveitis especially needs to be improved.
记录青少年类风湿性关节炎（JRA）的治疗方法对于评估未来疗效研究的实践模式很重要。1999年9月至2000年2月期间，对9名儿科风湿病学家进行了一项调查。每位医生前瞻性地记录了连续抽样的JRA患者（n = 395）的人口统计学和治疗信息。46%的儿童为少关节起病型JRA，35%为多关节起病型JRA，19%为全身起病型JRA。萘普生是最常开具的药物（55%的患者），其次是甲氨蝶呤（MTX），39%的患者使用该药物。69%接受MTX治疗的患者补充了叶酸（1毫克/天）。11%的儿童使用了依那西普。11%的患者接受了皮质类固醇治疗，13%接受皮质类固醇治疗的儿童服用了钙补充剂。8%的患者患有葡萄膜炎，其中79%病程呈慢性。尽管50%患有葡萄膜炎的儿童使用了全身性药物来控制眼部炎症，但其中30%的儿童眼睛出现了严重损伤。14%的患者需要使用胃保护药物。与1993年进行的类似调查结果相比，萘普生的使用频率没有显著变化，但现在萘丁美酮的处方更频繁，并且COX - 2抑制剂已被引入JRA的治疗中。用于JRA的二线药物也发生了变化，尽管MTX或皮质类固醇的使用频率没有改变。JRA仍然是执业儿科风湿病学家面临的治疗挑战。患者对目前可用药物的反应往往不完全。因此，需要评估新治疗药物在JRA中的应用，尤其需要改善JRA相关葡萄膜炎的治疗。
