Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Rheumatol Int. 2012 Oct;32(10):3055-60. doi: 10.1007/s00296-011-2084-7. Epub 2011 Sep 11.
We examined whether the use of non-steroidal anti-inflammatory drugs has decreased for the treatment of juvenile idiopathic arthritis in a cohort treated with aggressive modern therapy as well as potential factors influencing their use. We randomly sampled 100 of 377 patients with juvenile idiopathic arthritis treated by pediatric rheumatologists at our center between 2003 and 2008. We used electronic health records and detailed chart review to examine the trends of non-steroidal anti-inflammatory drug use and factors impacting use, including disease subtype, disease activity, adverse effects, and other medication use. Data were analyzed longitudinally using a non-linear mixed effects regression model. Ninety-two percent used non-steroidal anti-inflammatory drugs at some point and 70% at anti-inflammatory doses. At patients' last visit within the study time frame, 52% were using non-steroidal anti-inflammatory drugs and only 28% at anti-inflammatory doses, decreased from 79 and 56%, respectively, at their first visit. In 2003, 53% used an anti-inflammatory dose compared to 35% in 2008. Active joint count was significantly associated with non-steroidal anti-inflammatory drug use at anti-inflammatory doses, while methotrexate and biologic modifiers use, later calendar year, the presence of uveitis, and positive anti-nuclear antibody status were significant negative predictors. The use of non-steroidal anti-inflammatory drugs decreased significantly over time, with decreasing numbers of active joints, and when methotrexate or biologic modifiers were used. The number of patients currently using non-steroidal anti-inflammatory drugs is less than reported in series from the 1990s.
我们研究了在接受积极现代治疗的幼年特发性关节炎患者队列中，非甾体抗炎药的使用是否减少，以及影响其使用的潜在因素。我们随机抽取了 2003 年至 2008 年期间在我们中心接受儿科风湿病医生治疗的 377 名幼年特发性关节炎患者中的 100 名。我们使用电子健康记录和详细的图表审查来检查非甾体抗炎药使用的趋势以及影响使用的因素，包括疾病亚型、疾病活动度、不良反应和其他药物使用。使用非线性混合效应回归模型进行数据分析。92%的患者在某个时候使用过非甾体抗炎药，70%的患者使用过抗炎剂量。在研究时间框架内患者的最后一次就诊时，52%的患者正在使用非甾体抗炎药，只有 28%的患者使用抗炎剂量，与首次就诊时的 79%和 56%相比有所下降。2003 年，53%的患者使用抗炎剂量，而 2008 年这一比例为 35%。活跃关节计数与抗炎剂量下的非甾体抗炎药使用显著相关，而甲氨蝶呤和生物调节剂的使用、后年历、葡萄膜炎的存在以及抗核抗体阳性状态是显著的负预测因子。随着活跃关节数量的减少，以及甲氨蝶呤或生物调节剂的使用，非甾体抗炎药的使用随着时间的推移显著减少。目前使用非甾体抗炎药的患者数量少于 20 世纪 90 年代报道的数量。
