Dirençli juvenil romatoid artritte düşük doz oral metotreksat tedavisi
Küçük Resim Yok
Tarih
1998
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada nonsteroidal antienflamatuvar ilaçlarla yavaş etkili antiromatizmal ilaçlara yanıt vermeyen 12 juvenil romatoid artritli hastaya haftada bir 10 mg/m2 dozunda sekiz ile 24 ay süreyle (ortalama 18±6 ay) oral metotreksat tedavisi uygulanmıştır. Hastalar sekiz ile 16 yaş arasında (ortalama 10.9±2.4 yıl) olup hastalık süreleri iki ile dokuz yıl arasında (ortalama 4.5+1.6 yıl) değişmekteydi. Metotreksat tedavisinden önce tüm hastalarda poliartrit vardı. Çalışma öncesinde bütün hastalara hidroksiklorokin, dört hastaya ise ayrıca sulfasalazin tedavisi uygulanmıştı. Metotreksat tedavisinden sonra şiş eklemlerin sayısı ortalama % 47, şişlik indeksi % 55, hareket kısıtlılığı olan eklem sayısı % 52, eklem indeksi % 54 ve sabah sertliğinin süresi % 65 azaldı. Ayrıca, hemoglobin düzeyi dört (% 33) hastada 2 gr/dl üzerinde artış gösterirken trombosit sayısı ise üç (% 25) hastada 200.000/mm3 üzerinde azalma gösterdi. Eritrosit sedimentasyon hızı metotreksat tedavisinden önce ortalama 80±26 mm/saat iken tedavi sonrasında 32±18 mm/saat bulundu. Metotreksat tedavisi sırasında tedavinin kesilmesini gerektirecek herhangi bir yan etkiye rastlanmadı. Bütün hastaların tedaviye uyumu tamdı. Çalışmadan elde edilen verilere dayanarak, konvansiyonel tedaviye dirençli juvenil romatoid artritli hastalarda metotreksat tedavisinin etkin ve güvenilir olduğu ve bu hastalarda hastalığın daha erken dönemlerinde, hatta diğer ikinci basamak ilaçlardan daha önce kullanılması gerektiği sonucuna varıldı.
Twelve children with resistant juvenile rheumatoid arthritis were given 10 mg of oral methotrexate per square meter of body-surface area per week for eight to 24 months (mean±SD, 18±6 months). The patients were eight to 16 years old (mean 10.9+2.4 years) and the mean duration of the disease was 4.5±1.6 years (range, two to nine years). The patients had active polyarthritis at the onset of the methotrexate therapy. All the patients had used hydroxychloroquine, and four of them also sulfasalazine as second-line agents. Methotrexate therapy decreased swelling count by a mean of 47 percent, swelling index by 55 percent, articular count 52%, articular index by 54 percent and morning stiffness by 65 percent. In addition, methotrexate therapy increased hemoglobin value by more than 2 gm/dl in four (33%) patients and decreased the number of platelets by more than 200,000/mm3 in three (25%) patients. The erythrocyte sedimentation rate was 80+26 mm/hr and 32±18 mm/hr before and aftermethotrexate therapy, respectively. No adverse effects severe enough to withdraw methotrexate therapy were observed during the study. Compliance with methotrexate therapy was complete in all patients. From the data presented here, we conclude that low-dose oral methotrexate is an effective treatment for children with resistant juvenile rheumatoid arthritis. We recommend earlier consideration of methotrexate in place of other slow-acting antirheumatic drugs of cases of juvenile rheumatoid arthritis not responding well to usual therapy.
Twelve children with resistant juvenile rheumatoid arthritis were given 10 mg of oral methotrexate per square meter of body-surface area per week for eight to 24 months (mean±SD, 18±6 months). The patients were eight to 16 years old (mean 10.9+2.4 years) and the mean duration of the disease was 4.5±1.6 years (range, two to nine years). The patients had active polyarthritis at the onset of the methotrexate therapy. All the patients had used hydroxychloroquine, and four of them also sulfasalazine as second-line agents. Methotrexate therapy decreased swelling count by a mean of 47 percent, swelling index by 55 percent, articular count 52%, articular index by 54 percent and morning stiffness by 65 percent. In addition, methotrexate therapy increased hemoglobin value by more than 2 gm/dl in four (33%) patients and decreased the number of platelets by more than 200,000/mm3 in three (25%) patients. The erythrocyte sedimentation rate was 80+26 mm/hr and 32±18 mm/hr before and aftermethotrexate therapy, respectively. No adverse effects severe enough to withdraw methotrexate therapy were observed during the study. Compliance with methotrexate therapy was complete in all patients. From the data presented here, we conclude that low-dose oral methotrexate is an effective treatment for children with resistant juvenile rheumatoid arthritis. We recommend earlier consideration of methotrexate in place of other slow-acting antirheumatic drugs of cases of juvenile rheumatoid arthritis not responding well to usual therapy.
Açıklama
Anahtar Kelimeler
Genel ve Dahili Tıp, Pediatri
Kaynak
Çocuk Sağlığı ve Hastalıkları Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
41
Sayı
1
