Goldenstein-Schainberg C, Yoshinari N H
Disciplina de Reumatologia, Faculdade de Medicina, Universidade de São Paulo.
Rev Hosp Clin Fac Med Sao Paulo. 1997 Mar-Apr;52(2):90-5.
NSAIDs are first line drug in the treatment of juvenile chronic arthritis (JCA), mainly in pauciarticular onset. New agents such as naproxen and ibuprofen are frequently preferred because of equivalent efficacy, lower toxicity and longer half-life than salicilates. Antimalarics, sulphasalazine and penicilamine are good options in seronegative JCA, specially with limited articular involvement and in pauciarticular JCA that become polyarticular. However, in the absence of a response with these drugs and insevere polyarticular disease, seropositive JCA and in polyarticular involvement associated to systemic manifestations, low-dose methotrexate is our first choice. Steroids are important in specific life-threatening disease, severe fever and iritis, and should be discontinued as soon as possible. Cytotoxics and immunomodulators should be reserved for active disease unresponsive to conventional therapy.
非甾体抗炎药是治疗青少年慢性关节炎（JCA）的一线药物，主要用于少关节起病型。由于萘普生和布洛芬等新药与水杨酸盐相比疗效相当、毒性更低且半衰期更长，因此常被优先选用。抗疟药、柳氮磺胺吡啶和青霉胺是血清阴性JCA的良好选择，特别是在关节受累有限的情况下以及在变为多关节型的少关节型JCA中。然而，在这些药物治疗无效、严重多关节疾病、血清阳性JCA以及与全身表现相关的多关节受累情况下，低剂量甲氨蝶呤是我们的首选。类固醇在特定的危及生命的疾病、严重发热和虹膜炎中很重要，应尽快停药。细胞毒性药物和免疫调节剂应保留用于对传统治疗无反应的活动性疾病。
