Athreya B H, Cassidy J T
University of Pennsylvania School of Medicine, Philadelphia.
Rheum Dis Clin North Am. 1991 Nov;17(4):871-89.
Based on clinical experience and the aforementioned studies, a number of opinions can be entertained concerning the historically traditional conservative management of children with JRA. 1. Because the inflammatory changes of JRA on the bones and joints once established are irreversible in most children, there are ample theoretical reasons to start more effective therapy (if available) early. 2. Most of the currently available drugs control inflammation only partially or temporarily. 3. Most children stop taking the various SAARDS after approximately 2 years of disease because of lack of efficacy or the development of toxicity. 4. Whereas corticosteroids are the most potent and effective anti-inflammatory agents, long-term use in children, even in low dosage, is severely limited, especially by their effect on growth. 5. Methotrexate appears to be the most effective of the alternative agents and much safer than expected when used in the currently recommended protocol. 6. More effective therapy must await a better understanding of the pathogenesis of JRA, although currently available medications might be used more rationally by taking into consideration available pharmacologic studies.
基于临床经验和上述研究，对于幼年类风湿关节炎（JRA）患儿传统的保守治疗方法，可得出以下几点看法。1. 由于大多数儿童JRA在骨骼和关节上所产生的炎症一旦形成便不可逆转，因此有充分的理论依据尽早开始采用更有效的治疗方法（若有可用方法）。2. 目前大多数可用药物只能部分或暂时控制炎症。3. 由于疗效不佳或出现毒性反应，大多数患儿在患病约两年后便停止服用各种慢作用抗风湿药（SAARDs）。4. 尽管皮质类固醇是最有效且作用最强的抗炎药物，但即使是低剂量长期用于儿童，也受到严格限制，尤其是其对生长发育的影响。5. 甲氨蝶呤似乎是其他药物中最有效的，按照目前推荐的方案使用时，其安全性比预期要高得多。6. 更有效的治疗方法必须等待对JRA发病机制有更深入的了解，不过目前可通过参考现有药理学研究，更合理地使用现有药物。
