早期、联合治疗对幼年附着点炎相关性关节炎的疗效及预后研究

Study on the Efficacy and Prognosis of Early Combination Therapy in Juvenile Onset Enthesitis-Related Arthritis

目的探讨早期、甲氨蝶呤（MTX）联合柳氮磺胺吡啶（SASP）与传统的非甾体类抗炎药（NSAIDs）相比较，对幼年附着点炎相关性关节炎（ERA）疗效及预后的影响。方法符合条件的ERA患儿55例，分为对照组25例，采用传统治疗方法（NSAIDs＋必要时小剂量激素）；治疗组30例，接受联合免疫抑制治疗（NSAIDs＋SASP＋MTX）。经过5年的治疗随访，评价两组患儿的临床疗效、放射学进展、转归、安全性。结果治疗前，两组患儿各项主要参数比较，差异无统计学意义（P〉0，05）。治疗5年后，治疗组在临床症状、炎性指标、放射学进展方面疗效均优于对照组（P〈0．05）,治疗组与对照组在病情缓解率（87％，8．7％）和强直性脊柱炎（AS）发生率（4．0％，60．9％）方面差异有统计学意义（P〈0．05），在生长发育、不良反应、耐受性方面，两组差异无统计学意义（P〉0．05）。结论早期、联合MTX与SASP治疗ERA可以很好地缓解病情，且能延缓或阻止放射学进展，耐受性号，对患儿生长发育无不良彭响，

Objective To study the efficacy and prognosis of early combination therapy with methotrexate （ MTX ） and sul- fasalazine（SASP） and traditional therapy with NSAIDs in juvenile onset enthesitis-related arthritis（ERA）. Methods Fifty-five patients for ERA were divided into control group（ n =25） received conventional NSAIDs and low-dose corticoid needed,and treatment group（n = 30） re- ceived NSAIDs,SASP and MTX. Thruugh five years of therapy and follow-up,to evaluate the clinical efficacy,radiographic progression,prog- hosts and safety of two groups. Results At baseline,there was no statistical difference of the main parameters between two groups （ P 〉 0. 05 ）. Afler treatment,the efficacy of clinical symptoms,inilammatory index,and radiographic progression in treatment group were better than i that of control group（ P 〈0.05 ）. The remission rate was 87% compared to 8.7% ,and the incidence rate of AS was 4.0% compared to 60. 9% between treatment group and control group（ P 〈 0.05 ） , there was no signifieant difference in the growth and development, adverse effects, and tolerance between two groups（P〉0.05）. Conclusion Early combination therapy with MTX and sulfasalazine（SASP） in ERA can get better remission of disease,prevention of radiographic progression,well tolerance,and less adverse effects to children.