青少年のイディオパシー性関節炎の治療法
Philip J Hashkes1, Ronald M Laxer
1Section of Pediatric Rheumatology, Department of Rheumatic Diseases, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. hashkep@ccf.org
JAMA
|October 6, 2005
まとめ
ジュベニール・イディオパシー・関節炎 (JIA) の治療は進化しているが,一部のサブタイプについては証拠のギャップが残っている. 個別化された治療計画は,効果的なJIA管理に不可欠です.
科学分野:
- 小児リウマト病学について
- 根拠に基づいた医学は,証拠に基づいた医療です.
- クリニック・トライアル 臨床試験
背景:
- ジュベニールイディオパシー関節炎 (JIA) の治療は著しく進歩しました.
- 多くのJIA症例は,小児リウマトロジーの専門センターの外で管理されています.
研究 の 目的:
- JIAの治療戦略に関する既存の証拠を体系的に検討する.
- 最良の利用可能な研究に基づいて最適な治療アプローチを特定する.
主な方法:
- 主要なデータベースを介して英語のJIA試験 (1966-2005) の包括的な文献検索.
- ランダム化比較試験と,少なくとも10人の患者を対象とした公開試験を含む.
- 応答の評価に使用される標準化された結果指標.
主要な成果:
- NSAIDは,主に小関節炎に対して,限られた有効性を提供します.
- コルチコステロイド注射は,オリゴarthritisに対して非常に有効です.
- メソトレキサートは,拡張性オリゴarthritisおよび多関節炎に有効です.
- 抗TNF剤は,メトトレキサート耐性多節性JIAに対して高い有効性を示しています.
- システム性関節炎および腸炎に関連する関節炎の治療のための証拠は限られている.
結論:
- 治療の進歩にもかかわらず,特定のJIAサブタイプについては,証拠のギャップが残っています.
- JIAの治療決定は,疾患の特徴に基づいて慎重に個別化する必要があります.
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