原文

譯文

Ann Rheum Dis. 2011 Feb;70(2):337-40. Epub 2010 Nov 10.

Tumour necrosis factor (TNF)-blocking agents in juvenile psoriatic arthritis: are they effective?

Otten MH, Prince FH, Ten Cate R, van Rossum MA, Twilt M, Hoppenreijs EP, Koopman-Keemink Y, Oranje AP, de Waard-van der Spek FB, Gorter SL, Armbrust W, Dolman KM, Wulffraat NM, van Suijlekom-Smit LW.

Department of Paediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands. m.otten@erasmusmc.nl

Abstract

OBJECTIVES: To evaluate the effectiveness of tumour necrosis factor (TNF) blockers in juvenile psoriatic arthritis (JPsA).

METHODS: The study was a prospective ongoing multicentre, observational study of all Dutch juvenile idiopathic arthritis (JIA) patients using biologicals. The response of arthritis was assessed by American College of Rheumatology (ACR) paediatric response and Wallace inactive disease criteria. The response of psoriatic skin lesions was scored by a 5-point scale.

RESULTS: Eighteen JPsA patients (72% female, median age onset 11.1 (range 3.3-14.6) years, 50% psoriatic skin lesions, 39% nail pitting, 22% dactylitis) were studied. The median follow-up time since starting anti-TNFα was 26 (range 3-62) months. Seventeen patients started on etanercept and one started on adalimumab. After 3 months of treatment 83% of the patients achieved ACR30 response, increasing to 100% after 15 months. Inactive disease reached in 67% after 39 months. There was no discontinuation because of inefficacy. Six patients discontinued treatment after a good clinical response. However, five patients flared and restarted treatment, all with a good response. During treatment four patients (two JPsA and two JIA patients with other subtypes) developed de novo psoriasis. In four of the nine patients the pre-existing psoriatic skin lesions improved.

CONCLUSION: Anti-TNFα therapy in JPsA seems effective in treating arthritis. However, in most patients the arthritis flared up after treatment discontinuation, emphasising the need to investigate optimal therapy duration. The psoriatic skin lesions did not respond well and four patients developed de novo psoriasis.

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腫瘤壞死因子(TNF)阻斷劑治療幼年型銀屑病關節(jié)炎: 有效嗎

Otten MH, Prince FH, et al,Ann Rheum Dis. 2011 Feb;70(2):337-40. Epub 2010 Nov 10.

目的:評估腫瘤壞死因子(TNF)阻斷劑對幼年銀屑病關節(jié)炎(JPsA)的療效。

方法:本研究是包括荷蘭所有應用生物制劑的幼年型特發(fā)性關節(jié)炎患者的一項正在進行的前瞻性多中心、觀察性研究。關節(jié)炎療效評估根據(jù)美國風濕病協(xié)會(ACR)兒科反應和Wallace疾病不活動標準。銀屑病皮損的療效以5分制積分。

結(jié)果:18例JPsA 患者參與本研究，其中72%為女性,平均起病年齡11.1 (3.3-14.6) 歲,50%有銀屑病皮損,39%有指甲凹陷,22%有指/趾炎。依那西普治療開始后的隨訪中位數(shù)時間為26 (3-62)個月。17例患者應用依那昔普，1例用阿達木單抗。治療3個月后, 83%的患者達到ACR30反應, 15個月后增加到100%。39個月后疾病不活動的比例達到67%。沒有病例因無效而停藥。6例患者獲得良好的臨床療效后停藥。然而,有5例患者停藥后復發(fā)并重新治療,并再次獲得良好療效。4例患者治療過程中(2例JPsA和2例其他類型的JIA)出現(xiàn)新的銀屑病皮損。9例原有銀屑病皮損的患者中有4例皮損得到改善。

結(jié)論:抗-TNFα療法治療JPsA的關節(jié)炎癥狀似乎有效。然而,大部分患者停藥后會出現(xiàn)復發(fā)，強調(diào)探討最佳治療時間的必要性。銀屑病的皮膚損害反應不佳，并且有4例患者出現(xiàn)新的銀屑病。

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