Gottlieb B S, Keenan G F, Lu T, Ilowite N T
Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA.
Pediatrics. 1997 Dec;100(6):994-7. doi: 10.1542/peds.100.6.994.
Children with juvenile rheumatoid arthritis (JRA) treated with methotrexate (MTX) were examined for their course after the discontinuation of the drug to define the relapse and remission rates and to identify predictors of relapse.
A retrospective chart review of all patients with JRA was conducted in two pediatric rheumatology centers. A total of 101 patients being treated with MTX were identified. Dose, response to the drug, and length of time until reaching a state of complete control were noted. The outcome of patients with a complete response in whom the drug was discontinued was examined with regards to length of time to relapse or continued remission.
In 25 patients, MTX was discontinued after reaching complete control of the disease. There were no statistically significant predictors of response to MTX identified. Of 25 whose MTX was discontinued, relapse occurred in 13 (52%) after a mean of 11 months after discontinuation. There was no significant difference among patients who relapsed or those who remained in remission as to sex, subtype of JRA, number of months to complete control, or number of months in complete control until discontinuing MTX. Patients younger than 41/2 years at diagnosis were found to be more likely to relapse than patients diagnosed at a later age. In 10 of the patients who relapsed, complete control was induced within a mean of 7 months after restarting MTX.
The optimal time for discontinuing MTX in children with JRA who have achieved complete control is unknown. Relapse occurred in approximately half of the patients in whom MTX was discontinued. Because response to reinstitution of the drug is good, it is reasonable to discontinue MTX after prolonged complete control. It remains to be seen whether the relapse rate can be improved by waiting for longer periods of time in complete control before its discontinuation.
对接受甲氨蝶呤（MTX）治疗的幼年类风湿关节炎（JRA）患儿在停药后的病程进行检查，以确定复发率和缓解率，并找出复发的预测因素。
在两个儿科风湿病中心对所有JRA患者进行回顾性病历审查。共确定了101例接受MTX治疗的患者。记录剂量、对药物的反应以及达到完全控制状态所需的时间。对药物停用后完全缓解的患者的结局，就复发时间或持续缓解时间进行检查。
25例患者在疾病完全控制后停用MTX。未发现对MTX反应有统计学意义的预测因素。在停用MTX的25例患者中，13例（52%）在停药后平均11个月复发。复发患者与仍处于缓解状态的患者在性别、JRA亚型、达到完全控制的月数或停用MTX前完全控制的月数方面无显著差异。发现诊断时年龄小于4.5岁的患者比年龄较大时诊断的患者更易复发。在10例复发患者中，重新开始使用MTX后平均7个月内诱导出完全缓解。
对于已实现完全控制的JRA患儿，停用MTX的最佳时间尚不清楚。停用MTX的患者中约有一半复发。由于重新使用该药物的反应良好，在长期完全控制后停用MTX是合理的。在完全控制后等待更长时间再停药是否能提高复发率还有待观察。
