Céspedes-Cruz A, Gutiérrez-Suárez R, Pistorio A, Ravelli A, Loy A, Murray K J, Gerloni V, Wulffraat N, Oliveira S, Walsh J, Penades I Calvo, Alpigiani M G, Lahdenne P, Saad-Magalhães C, Cortis E, Lepore L, Kimura Y, Wouters C, Martini A, Ruperto N
IRCCS G Gaslini, Pediatria II, Reumatologia, PRINTO, Largo Gaslini, 5, 16147 Genova, Italy.
Ann Rheum Dis. 2008 Mar;67(3):309-14. doi: 10.1136/ard.2007.075895. Epub 2007 Sep 17.
To examine the change in health-related quality of life (HRQOL) and its determinants in children with juvenile idiopathic arthritis (JIA) treated with methotrexate (MTX).
Patients were extracted from the PRINTO clinical trial which aimed to evaluate the efficacy and safety profile of MTX administered in standard, intermediate or higher doses (10, 15 and 30 mg/m(2)/week respectively). Children with polyarticular-course JIA, who were less than 18 years and had a complete HRQOL assessment were included.
A total of 521 children were included. At baseline, patients with JIA showed poorer HRQOL (p<0.01) than healthy children. In 207/412 (50%) and 63 (15%) children, HRQOL values were 2 standard deviations below the mean of healthy controls in the physical and psychosocial summary scale, respectively. After 6 months of treatment with standard dose MTX, there was a statistically significant improvement in all HRQOL health concepts, particularly the physical ones. Similar improvements were observed in those who did not respond to a standard dose of MTX and were subsequently randomised to a higher dose. The presence of marked disability at baseline was associated with a fivefold increased risk of retaining poor physical health after 6 months of active treatment with standard dose MTX. Other less important determinants of retaining poor physical well-being were the baseline level of systemic inflammation, pain intensity and an antinuclear-antibody-negative status.
MTX treatment produces a significant improvement across a wide range of HRQOL components, particularly in the physical domains, in patients with JIA.
研究甲氨蝶呤（MTX）治疗的幼年特发性关节炎（JIA）患儿健康相关生活质量（HRQOL）的变化及其决定因素。
从PRINTO临床试验中选取患者，该试验旨在评估标准剂量、中等剂量或高剂量（分别为10、15和30mg/m²/周）MTX的疗效和安全性。纳入年龄小于18岁、有多关节型JIA且进行了完整HRQOL评估的儿童。
共纳入521名儿童。基线时，JIA患者的HRQOL较健康儿童差（p<0.01）。在207/412名（50%）和63名（15%）儿童中，身体和心理社会总结量表的HRQOL值分别比健康对照的平均值低2个标准差。标准剂量MTX治疗6个月后，所有HRQOL健康概念均有统计学显著改善，尤其是身体方面。在未对标准剂量MTX产生反应且随后被随机分配至更高剂量的患者中也观察到类似改善。基线时存在明显残疾与标准剂量MTX积极治疗6个月后身体状况仍较差的风险增加五倍相关。身体状况仍较差的其他不太重要的决定因素是全身炎症的基线水平、疼痛强度和抗核抗体阴性状态。
MTX治疗可使JIA患者的广泛HRQOL成分有显著改善，尤其是在身体领域。
