Sulpice Moana, Deslandre Chantal Job, Quartier Pierre
Hôpital de Dreux, Dreux, France.
Joint Bone Spine. 2009 Jan;76(1):24-7. doi: 10.1016/j.jbspin.2008.03.008. Epub 2008 Dec 12.
To evaluate the efficacy and safety of TNFalpha antagonist therapy in patients with juvenile spondyloarthropathies refractory to nonsteroidal anti-inflammatory drugs (NSAIDs).
Retrospective review of the medical charts of 20 patients (16 males and 4 females) with a mean age of 11.6 years at diagnosis. Median time from diagnosis to initiation of TNFalpha antagonist therapy was 41 months. Escape phenomenon developed in 3 patients, who were switched to another TNFalpha antagonist. Etanercept was used for 19/23 treatments, infliximab for 3/23 treatments, and adalimumab for 1 treatment. The efficacy criteria were morning stiffness duration; nocturnal awakenings; tender and swollen joint counts; entheseal count; back, buttock, and hip pain; percentage of patients on NSAIDs and/or glucocorticoid therapy; and mean and median values of the erythrocyte sedimentation rate, C-reactive protein level, and hemoglobin level. A remission was defined as resolution of the axial and peripheral pain, joint swelling, and laboratory evidence of inflammation, with or without continued NSAID therapy.
TNFalpha antagonist therapy was associated with clinical and laboratory improvements after 3 months, and the benefits were sustained after 1 year. Axial pain required 6 months to improve. A remission was achieved in 59% of patients after 3 months and 70% after 6 and 12 months. Median time to remission under treatment was 3 months. The interval between the TNFalpha antagonist injections was increased for 12/18 treatments and the treatment was stopped in 7 cases. However, treatment discontinuation was consistently followed by a relapse, after a median time of 2.5 months. Two serious adverse events occurred, namely, acute bacterial pneumonia and recurrent impetigo; in both cases the outcome was promptly favorable after a brief interruption of the TNFalpha antagonist.
TNFalpha antagonist therapy seems safe and rapidly effective in patients with juvenile spondyloarthropathies refractory to NSAIDs, in keeping with data from adults. However, prospective studies in larger patient populations are needed.
评估肿瘤坏死因子α（TNFα）拮抗剂疗法对非甾体抗炎药（NSAIDs）治疗无效的青少年脊柱关节病患者的疗效和安全性。
回顾性分析20例患者（16例男性，4例女性）的病历，诊断时平均年龄为11.6岁。从诊断到开始使用TNFα拮抗剂治疗的中位时间为41个月。3例患者出现逃逸现象，转而使用另一种TNFα拮抗剂。19/23次治疗使用依那西普，3/23次治疗使用英夫利昔单抗，1次治疗使用阿达木单抗。疗效标准包括晨僵持续时间、夜间觉醒次数、压痛和肿胀关节数、附着点计数、背部、臀部和髋部疼痛、使用NSAIDs和/或糖皮质激素治疗的患者百分比，以及红细胞沉降率、C反应蛋白水平和血红蛋白水平的均值和中位数。缓解定义为轴向和外周疼痛、关节肿胀及炎症实验室证据消失，无论是否继续使用NSAIDs治疗。
TNFα拮抗剂治疗3个月后临床和实验室指标有所改善，且1年后仍持续有效。轴向疼痛需6个月改善。3个月后59%的患者实现缓解，6个月和12个月后分别为70%。治疗下达到缓解的中位时间为3个月。18次治疗中有12次增加了TNFα拮抗剂注射间隔时间，7例患者停止治疗。然而，停止治疗后均出现复发，中位复发时间为2.5个月。发生了2例严重不良事件，即急性细菌性肺炎和复发性脓疱病；两例在短暂中断TNFα拮抗剂治疗后结果均迅速好转。
TNFα拮抗剂疗法对NSAIDs治疗无效的青少年脊柱关节病患者似乎安全且起效迅速，与成人数据一致。然而，需要对更大规模患者群体进行前瞻性研究。
