Savolainen H A, Kautiainen H, Isomäki H, Aho K, Verronen P
Rheumatism Foundation Hospital, Heinola, Finland.
J Rheumatol. 1997 Dec;24(12):2444-50.
To evaluate drug survival, efficacy, side effects, and longterm toxicity of azathioprine treatment in patients with juvenile chronic arthritis (JCA).
In an uncontrolled, prospective study we evaluated 129 consecutive patients with JCA refractory to therapy in whom azathioprine treatment was begun during 1980-1989. In the first 29 patients, a 2 year trial was planned, while for the remaining 100 patients the protocol was to continue until remission or dropout. The median treatment period was 13 months (range 3 days-8.5 yrs). Patients were assessed every 2 months for 2 years for efficacy, side effects, growth and need for glucocorticoids, and outcome evaluated in late 1996.
Remission without drugs was attained in 19 patients (15%); in addition, temporary remission in patients continuing treatment was attained in 18 cases (14%). Treatment was discontinued due to side effects in 18 cases (14%); in two-thirds of these cases side effects occurred during the first 2 months. Of the total number of patients, 49 (38%) completed 2 years of treatment, with significant improvement in both clinical and laboratory indices of disease activity. Treatment had no noticeable effect on iridocyclitis. One patient died of cytomegalovirus infection during azathioprine treatment.
Azathioprine is a useful drug in severe JCA, with a sustained effect and acceptable side effects. Even in cases of incomplete remission, its glucocorticoid sparing effect was noteworthy.
评估硫唑嘌呤治疗青少年慢性关节炎（JCA）患者的药物留存率、疗效、副作用及长期毒性。
在一项非对照前瞻性研究中，我们评估了1980年至1989年间开始使用硫唑嘌呤治疗的129例连续的JCA难治性患者。前29例患者计划进行为期2年的试验，而其余100例患者的方案是持续治疗直至缓解或退出。中位治疗期为13个月（范围3天至8.5年）。每2个月对患者进行一次评估，持续2年，评估疗效、副作用、生长情况及对糖皮质激素的需求，并于1996年末评估结局。
19例患者（15%）实现了无药缓解；此外，继续治疗的患者中有18例（14%）实现了暂时缓解。18例患者（14%）因副作用而停药；其中三分之二的病例在最初2个月内出现副作用。在所有患者中，49例（38%）完成了2年治疗，疾病活动的临床和实验室指标均有显著改善。治疗对虹膜睫状体炎无明显效果。1例患者在硫唑嘌呤治疗期间死于巨细胞病毒感染。
硫唑嘌呤是治疗重度JCA的有效药物，具有持续疗效且副作用可接受。即使在不完全缓解的病例中，其糖皮质激素节省作用也值得注意。
