青少年异常性关节炎的医疗治疗
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
概括
青少年无形性关节炎 (JIA) 治疗已经进化,但对于某些亚型仍然存在证据缺口. 个性化治疗计划对于有效的JIA管理至关重要.
科学领域:
- 儿科风湿病学 儿科风湿病学
- 基于证据的医学基于证据的医学.
- 临床试验 临床试验
背景情况:
- 青春期异常性关节炎 (JIA) 治疗已经显著进步.
- 许多JIA病例在专门的儿科风湿病学中心之外进行管理.
研究的目的:
- 系统地审查JIA治疗策略的现有证据.
- 根据最好的可用研究来确定最佳的治疗方法.
主要方法:
- 在主要数据库中对英语JIA试验 (1966-2005) 进行全面的文献搜索.
- 包括随机对照试验和至少10名患者的开放研究.
- 用于响应评估的标准化结果措施.
主要成果:
- 无 NSAIDs 的疗效有限,主要用于小关节炎.
- 皮质类固醇注射对于小关节炎非常有效.
- 甲托雷克萨特是有效的扩展性骨关节炎和多关节炎.
- 抗TNF药物对抗甲基酸耐火性多关节性JIA具有很高的疗效.
- 对于治疗全身性关节炎和与肠炎相关的关节炎的证据有限.
结论:
- 尽管治疗方面取得了进展,但对于特定的JIA亚型仍然存在证据缺口.
- 对JIA的治疗决定需要根据疾病特征进行仔细的个性化.
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