非甾体类消炎药联合甲氨蝶呤治疗全身型幼年特发性关节炎疗效观察

目的探讨非甾体类消炎药(NSAIDs)联合甲氨蝶呤(MTX)治疗全身型幼年特发性关节炎(SO-JIA)的疗效。方法分析比较32例SO-JIA患儿以NSAIDs联合MTX治疗后临床症状的变化,关节炎病情改善评估参照美国风湿病学会推荐的类风湿性关节炎改善标准。结果32例患儿治疗后,体温恢复正常27例,退热有效率为84.4%(27/32例),5例加用糖皮质激素后热退;31例关节炎症状改善,有效率为96.9%(31/32例),1例加用来氟米特后关节炎症状缓解。停药观察3例,复发1例。结论SO-JIA诊断确立后应尽早予NSAIDs联合MTX治疗,NSAIDs能较好地退热及减轻关节症状,MTX可有效持续改善关节炎症。糖皮质激素不作为首选退热用药。

Nonsteriodal Antiinflammatory Drugs in combination with methotrexate in systemic onset juvenile idiopathic arthritis

Objective To investigate the effect of Nonsteriodal Antiinflammatory Drugs(NSAIDs) combined with methotrexate (MTX) on children with systemic onset juvenile idiopathic arthritis (SO-JIA). Methods The changes of clinical manifestations before and after treatment of NSAIDs combined with MTX were analyzed in 32 children with SO-JIA. Preliminary definition of improvement of rheumatoid arthritis recommended by American College of Rheumatology was used for the evaluation of curative effect. Results The body temperature was back to normal in 27 cases of 32 children with SO-JIA (84.4%) after treatment of NSAIDs combined with MTX and other 5 cases needed to use corticosteroids additionally for the fall of the body temperature. Symptoms of arthritis was improved in 31 cases with the efficiency of 96.9% (31/32). However,Leflunomide was required to relieve symptoms of arthritis in the rest one. One case had a replase in all 3 cases who stopped drug treatment. Conclusions It is necessary that both of NSAIDs and MTX shall be administrated in patients with SO- JIA as soon as possible once the diagnosis of SO- JIA is confirmed. NSAIDs is helpful to alleviates fever and joint symptoms,and MTX can improve symptoms of arthritis consistently. Corticosteroid is not the first choice of antipyretic agents for the treatment of SO- JIA in children.