Richards B L, Spies J, McGill N, Richards G W, Vaile J, Bleasel J F, Youssef P P
Department of Rheumatology, The Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Intern Med J. 2007 Feb;37(2):101-7. doi: 10.1111/j.1445-5994.2007.01266.x.
The objective of this study was to determine the neurophysiological effects of leflunomide on peripheral nerves in rheumatoid arthritis.
We conducted a prospective cohort trial of 32 patients with rheumatoid arthritis with 16 patients receiving leflunomide treatment and 16 receiving other disease-modifying anti-rheumatic drug therapies. Clinical, laboratory and neurophysiological measurements were used to determine the presence of a peripheral neuropathy in these patients at study entry and then after a further 3 and 6 months.
Fifty-four per cent of the leflunomide group and 8% of the control group had an increase in their neuropathy symptom score 6 months into the study (P = 0.01). No correlation was found between the electrophysiological findings and the clinical symptoms. There was no significant difference between the two groups in upper and lower limb sensory and motor amplitudes and conduction velocities recorded at 3 and 6 months. One patient developed both clinical and neurophysiological evidence of a peripheral neuropathy 5 months into the study that improved after cessation of leflunomide therapy and cholestyramine washout.
After 6 months of exposure we found that leflunomide was associated with an apparent increase in the clinical symptoms of peripheral neuropathy in patients with rheumatoid arthritis. These symptoms did not correlate with neurophysiological studies.
本研究的目的是确定来氟米特对类风湿关节炎患者周围神经的神经生理学影响。
我们对32例类风湿关节炎患者进行了一项前瞻性队列试验，其中16例接受来氟米特治疗，16例接受其他改善病情抗风湿药物治疗。在研究开始时以及之后3个月和6个月，使用临床、实验室和神经生理学测量方法来确定这些患者是否存在周围神经病变。
研究6个月时，来氟米特组54%的患者和对照组8%的患者神经病变症状评分增加（P = 0.01）。电生理检查结果与临床症状之间未发现相关性。两组在3个月和6个月时记录的上肢和下肢感觉及运动幅度和传导速度无显著差异。1例患者在研究5个月时出现周围神经病变的临床和神经生理学证据，在停用 来氟米特治疗和进行考来烯胺洗脱后病情改善。
暴露6个月后，我们发现来氟米特与类风湿关节炎患者周围神经病变的临床症状明显增加有关。这些症状与神经生理学研究结果无关。
