Richards I M, Fraser S M, Hunter J A, Capell H A
Centre for Rheumatic Diseases, Glasgow Royal Infirmary.
Ann Rheum Dis. 1987 Sep;46(9):667-9. doi: 10.1136/ard.46.9.667.
Phenytoin has known immunosuppressive properties, and a recent pilot study has indicated that it may have a second line effect in rheumatoid arthritis (RA). To evaluate this role 60 patients with active RA were randomly allocated to receive either oral phenytoin or intramuscular gold. The two treatment groups were comparable at the outset (Mann-Whitney U test). Twenty four patients completed 24 weeks of therapy in each group and no unexpected side effects were encountered. All variables except haemoglobin (Hb) improved significantly in the gold group while in the phenytoin group significant improvement was limited to articular index, erythrocyte sedimentation rate (ESR), and Hb. Between group comparison (Mann-Whitney) at week 24 showed a significant advantage of gold over phenytoin for pain score and morning stiffness. Thus phenytoin appears to exert a less potent second line effect than gold and is unusual in influencing laboratory indicators of disease activity more than clinical variables. This is likely to limit its usefulness as a second line drug in RA.
苯妥英具有已知的免疫抑制特性，最近的一项初步研究表明，它在类风湿性关节炎（RA）中可能具有二线治疗作用。为评估这一作用，60例活动期RA患者被随机分配接受口服苯妥英或肌肉注射金制剂。两组治疗开始时具有可比性（曼-惠特尼U检验）。每组24例患者完成了24周的治疗，未出现意外的副作用。金制剂组除血红蛋白（Hb）外的所有变量均有显著改善，而苯妥英组的显著改善仅限于关节指数、红细胞沉降率（ESR）和Hb。第24周时组间比较（曼-惠特尼检验）显示，金制剂在疼痛评分和晨僵方面比苯妥英有显著优势。因此，苯妥英似乎比金制剂的二线治疗作用更弱，而且与临床变量相比，它对疾病活动实验室指标的影响更为显著，这很可能会限制其作为RA二线药物的效用。
