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定义幼年特发性关节炎缓解和最佳时机以停止疾病修饰抗风湿药物治疗:我们为何需要达成共识。

Defining juvenile idiopathic arthritis remission and optimum time for disease-modifying anti-rheumatic drug withdrawal: why we need a consensus.

机构信息

University of East Anglia, Norwich, Norfolk, UK.

出版信息

Paediatr Drugs. 2012 Feb 1;14(1):7-12. doi: 10.2165/11595980-000000000-00000.

Abstract

Juvenile idiopathic arthritis (JIA) is an autoimmune disease of childhood requiring treatment with immune modulation therapy. It runs a relapsing and remitting course, with approximately half of affected children continuing with active disease into adult life. Defining clinical remission is challenging, but necessary, as it is critical in determining when potentially toxic therapy can be stopped. We found that preliminary consensus criteria for defining JIA remission are not being used in full by a representative sample of UK pediatric rheumatologists. Extending the period of remission, whilst on synthetic disease-modifying anti-rheumatic drug (DMARD) medication, beyond 6 months does not seem to reduce the risk of relapse once medication is stopped. However, we found that most clinicians state that they still require at least 1 year in remission before DMARD withdrawal. There is increasing evidence that subclinical biomarkers may help to assess disease activity, and therefore aid clinicians in determining remission. In this review we argue that agreement on remission criteria and optimum timing of DMARD withdrawal is crucial for consistent clinical practice, and further research in this area is needed.

摘要

幼年特发性关节炎(JIA)是一种儿童期自身免疫性疾病,需要免疫调节治疗。它呈反复发作和缓解的病程,约有一半受影响的儿童在成年后仍有活动性疾病。定义临床缓解具有挑战性,但却是必要的,因为这对于确定何时可以停止潜在有毒的治疗至关重要。我们发现,英国儿科风湿病学家的代表性样本并未充分使用用于定义 JIA 缓解的初步共识标准。在停止药物治疗后,将缓解期(在使用合成疾病修饰抗风湿药物(DMARD)药物时)延长至 6 个月以上,似乎并不会降低停药后复发的风险。但是,我们发现大多数临床医生表示,他们仍需要至少 1 年的缓解期才能停用 DMARD。越来越多的证据表明,亚临床生物标志物可能有助于评估疾病活动,从而帮助临床医生确定缓解。在这篇综述中,我们认为,就缓解标准和 DMARD 停药的最佳时机达成一致对于一致的临床实践至关重要,并且需要在这一领域进行进一步的研究。

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