肿瘤坏死因子(TNF)阻断剂治疗幼年型银屑病关节炎: 有效吗

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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.

肿瘤坏死因子(TNF)阻断剂治疗幼年型银屑病关节炎: 有效吗 Otten MH, Prince FH, et al,Ann Rheum Dis. 2011 Feb;70(2):337-40. Epub 2010 Nov 10. 目的:评估肿瘤坏死因子(TNF)阻断剂对幼年银屑病关节炎(JPsA)的疗效。 方法:本研究是包括荷兰所有应用生物制剂的幼年型特发性关节炎患者的一项正在进行的前瞻性多中心、观察性研究。关节炎疗效评估根据美国风湿病协会(ACR)儿科反应和Wallace疾病不活动标准。银屑病皮损的疗效以5分制积分。 结果:18例JPsA 患者参与本研究，其中72%为女性,平均起病年龄11.1 (3.3-14.6) 岁,50%有银屑病皮损,39%有指甲凹陷,22%有指/趾炎。依那西普治疗开始后的随访中位数时间为26 (3-62)个月。17例患者应用依那昔普，1例用阿达木单抗。治疗3个月后, 83%的患者达到ACR30反应, 15个月后增加到100%。39个月后疾病不活动的比例达到67%。没有病例因无效而停药。6例患者获得良好的临床疗效后停药。然而,有5例患者停药后复发并重新治疗,并再次获得良好疗效。4例患者治疗过程中(2例JPsA和2例其他类型的JIA)出现新的银屑病皮损。9例原有银屑病皮损的患者中有4例皮损得到改善。 结论:抗-TNFα疗法治疗JPsA的关节炎症状似乎有效。然而,大部分患者停药后会出现复发，强调探讨最佳治疗时间的必要性。银屑病的皮肤损害反应不佳，并且有4例患者出现新的银屑病。