接受生物制剂治疗的幼年特发性关节炎患者的炎症性肠病
Inflammatory Bowel Disease in Juvenile Idiopathic Arthritis Patients Treated with Biologics.
作者信息
Barthel Deborah, Ganser Gerd, Kuester Rolf-Michael, Onken Nils, Minden Kirsten, Girschick Hermann Josef, Hospach Anton, Horneff Gerd
机构信息
From the Department of Pediatrics, Asklepios Klinik Sankt Augustin, Sankt Augustin; Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst; Asklepios Rheumazentrum Hamburg, Hamburg; Pediatric Practice, Lueneburg; Deutsches Rheuma-Forschungszentrum, Berlin; Department of Pediatrics, Vivantes Klinikum im Friedrichshain, Berlin; Department of Pediatrics, Klinikum Stuttgart, Stuttgart, Germany.D. Barthel, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin; G. Ganser, MD, Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst; R.M. Kuester, MD, Senior Consultant, Asklepios Rheumazentrum Hamburg; N. Onken, MD, Pediatric Practice; K. Minden, MD, Deutsches Rheuma-Forschungszentrum; H.J. Girschick, MD, Department of Pediatrics, Vivantes Klinikum im Friedrichshain; A. Hospach, MD, Department of Pediatrics, Klinikum Stuttgart; G. Horneff, MD, Department of Pediatrics, Asklepios Klinik Sankt Augustin.
出版信息
J Rheumatol. 2015 Nov;42(11):2160-5. doi: 10.3899/jrheum.140472. Epub 2015 Sep 15.
OBJECTIVE
Evolving inflammatory bowel disease (IBD) is a matter of interest in patients with juvenile idiopathic arthritis (JIA) and might be associated with JIA therapy.
METHODS
Data from the German biologics registry (Biologika in der Kinderrheumatologie; BiKeR) from 2001 to 2013 were analyzed.
RESULTS
There were 3071 patients with 8389 patient-years (PY) of observation followed. IBD was diagnosed in 11 patients, 8 with Crohn disease and 3 with ulcerative colitis. IBD incidence in patients with JIA was 1.31/1000 PY and higher than published IBD incidences in pediatric populations. Compared with the total BiKeR cohort, patients with IBD more commonly had enthesitis-related arthritis, extended oligoarthritis, psoriatic arthritis, and also rheumatoid factor (RF)-negative polyarthritis. No IBD occurred in patients with systemic JIA or RF-positive polyarthritis. In patients treated with methotrexate (MTX), the IBD incidence was significantly lower compared with patients not treated with MTX. Etanercept (ETN) monotherapy, but not the combination of ETN and MTX, was associated with an increased incidence of IBD.
CONCLUSION
Incidence of IBD in patients with JIA is higher than in the population. MTX turned out to be protective, even in combination with ETN.
目的
在幼年特发性关节炎（JIA）患者中，炎症性肠病（IBD）的病情演变备受关注，且可能与JIA治疗相关。
方法
分析了德国生物制剂注册中心（儿童风湿病生物制剂登记处；BiKeR）2001年至2013年的数据。
结果
共纳入3071例患者，随访观察8389患者年（PY）。11例患者被诊断为IBD，其中8例为克罗恩病，3例为溃疡性结肠炎。JIA患者的IBD发病率为1.31/1000 PY，高于已发表的儿科人群IBD发病率。与整个BiKeR队列相比，IBD患者更常患附着点炎相关关节炎、扩展性少关节炎、银屑病关节炎以及类风湿因子（RF）阴性多关节炎。系统性JIA或RF阳性多关节炎患者未发生IBD。与未接受甲氨蝶呤（MTX）治疗的患者相比，接受MTX治疗的患者IBD发病率显著降低。依那西普（ETN）单药治疗而非ETN与MTX联合治疗与IBD发病率增加相关。
结论
JIA患者的IBD发病率高于普通人群。结果表明MTX具有保护作用，即使与ETN联合使用时也是如此。
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