Horneff Gerd, Augustin Sankt
Asklepios Klinik Sankt Augustin, Arnold-Janssen-Str 29, 53757 Sankt Augustin.
Med Monatsschr Pharm. 2008 Sep;31(9):326-36; quiz 337-8.
Juvenile idiopathic arthritis is the most common chronic autoimmune disease. The outcome of this inflammatory disease is uncertain. Patients may suffer from severe joint damage leading to mutilations as well as from extraarticular manifestations. The prognosis is variable and depends in part on the number of affected joints and the occurrence of extraarticular manifestations. Pharmacomedical treatment has changed markedly in the last decade. It consists of a combination therapy including nonsteroidal antirheumatics, glucocorticoids either systemic or intraarticular, classical disease modifying drugs like sulfasalazine and methotrexate as well as leflunomide and biologicals. These new therapeutic strategies have effected dramatic improvements also in patients with severe, so far intractable disease. The TNF inhibitors etanercept and adalimumab have succeeded in double blind controlled trials, while infliximab failed to show significant superiority over placebo. Further treatment options include inhibitors of interleukin 1 (anakinra and rilonacept), interleukin 6 (tocilizumab) and inhibitors of T-cell activation (abatacept). This review will summarize the pharmacotherapeutic options based on studies published in the literature.
青少年特发性关节炎是最常见的慢性自身免疫性疾病。这种炎症性疾病的预后尚不确定。患者可能会遭受导致肢体残缺的严重关节损伤以及关节外表现。预后因人而异，部分取决于受累关节的数量和关节外表现的出现情况。在过去十年中，药物治疗发生了显著变化。它包括联合治疗，其中有非甾体类抗风湿药、全身或关节内使用的糖皮质激素、诸如柳氮磺胺吡啶和甲氨蝶呤等传统改善病情药物以及来氟米特和生物制剂。这些新的治疗策略也使重症患者（迄今为止难以治疗的疾病）有了显著改善。肿瘤坏死因子抑制剂依那西普和阿达木单抗在双盲对照试验中取得了成功，而英夫利昔单抗并未显示出比安慰剂有显著优势。进一步的治疗选择包括白细胞介素1抑制剂（阿那白滞素和利罗那肽）、白细胞介素6抑制剂（托珠单抗）以及T细胞活化抑制剂（阿巴西普）。本综述将基于文献中发表的研究总结药物治疗选择。
