Ravelli A, Viola S, Ramenghi B, Aramini L, Ruperto N, Martini A
Clinica Pediatrica dell'Università, Istituto di Ricovero e Cura a Carattere Scientifico S. Matteo, Pavia, Italy.
J Rheumatol. 1995 Aug;22(8):1574-6.
To investigate the outcome of children with juvenile rheumatoid arthritis (JRA) who discontinued taking methotrexate (MTX) therapy after the achievement of clinical remission.
We conducted a retrospective review of the clinical course of all consecutive patients with JRA treated with MTX at our department.
Seventeen of the 30 patients who responded to treatment entered clinical remission 6 to 30 mo after beginning MTX therapy. All patients were discontinued from MTX within 2 to 5 mo. Five patients relapsed within 9 mo, whereas 12 patients had sustained remission for 12 mo or longer. Four of 5 children with extended pauciarticular JRA relapsed early after MTX discontinuation. These patients were less responsive to a further cycle of MTX, and 3 showed progression of radiographic joint lesions.
These findings suggest that MTX should be continued in patients with extended pauciarticular JRA even after the achievement of clinical remission.
研究幼年类风湿关节炎（JRA）患儿在临床缓解后停用甲氨蝶呤（MTX）治疗的结果。
我们对在我科接受MTX治疗的所有连续性JRA患者的临床病程进行了回顾性分析。
30例治疗有反应的患者中，17例在开始MTX治疗后6至30个月进入临床缓解期。所有患者在2至5个月内停用MTX。5例患者在9个月内复发，而12例患者持续缓解12个月或更长时间。5例扩展性少关节型JRA患儿中有4例在停用MTX后早期复发。这些患者对进一步的MTX治疗周期反应较差，3例出现影像学关节病变进展。
这些发现表明，即使已实现临床缓解，扩展性少关节型JRA患者仍应继续使用MTX。
