Efficacy of Traditional and Biologic Agents in Different Clinical Phenotypes of Adult-Onset Still's Disease
Efficacy of Traditional and Biologic Agents in Different Clinical Phenotypes of Adult-Onset Still's Disease
复制标题
DOI：
10.1002/art.27532
复制
发表时间：
2010-08-01
影响因子：
--
通讯作者：
Sabbadini, Maria Grazia
中科院分区：
文献类型：
--
作者：
Franchini, Stefano;Dagna, Lorenzo;Sabbadini, Maria Grazia
目标。目的：评价抗炎药、类固醇、免疫抑制剂和生物制剂在患有慢性关节疾病或非慢性疾病的成人发病斯蒂尔斯病（AOSD）患者中的疗效。从1991年到2008年，我们对45例AOSD患者进行了至少2年的随访。大多数患者接受了几种治疗方案；总共进行了152项疗效试验。收集和分析了有关药物类型、使用剂量和这些试验结果的数据。我们的数据显示，非甾体类抗炎药单药治疗的疗效非常低（16%），类固醇治疗的疗效很好（63%），特别是对无慢性关节疾病的患者（78%）。在疾病发病时对类固醇治疗无反应的患者有随后发展为慢性关节炎的风险。改善疾病的抗风湿药物（DMARD）单药治疗成功地控制了60%的患者的类固醇耐药或类固醇依赖疾病。甲氨蝶呤和环孢素的有效率最好。大剂量类固醇联合环孢素成功控制了一些危及生命的急性并发症。只有6例患者同时具有类固醇耐药和DMARD耐药。6例患者中有5例（83%）经生物制剂治疗后，疾病表现得到满意控制。类固醇对慢性关节疾病患者的疗效低于非慢性疾病患者。在疾病发病后早期给予DMARDs可能对具有慢性关节疾病发展风险的类固醇抵抗性疾病患者有益。生物制剂被证明对类固醇耐药和dmard耐药AOSD都非常有效。
Objective. To evaluate the efficacy of antiinflammatory agents, steroids, immunosuppressants, and biologic agents in patients with adult-onset Still's disease (AOSD) who have either chronic articular disease or nonchronic disease.Methods. Forty-five patients with AOSD were seen and followed up for at least 2 years at our institution, from 1991 to 2008. The majority of patients were treated with several therapeutic regimens; a total of 152 efficacy trials were administered. Data regarding the type of medication, the dosage used, and the outcome of these trials were collected and analyzed.Results. Our data showed that the efficacy of monotherapy with a nonsteroidal antiinflammatory drug was very low (16%) and confirmed good efficacy of steroid therapy (63%), particularly in patients without chronic articular disease (78%). Patients whose disease did not respond to steroid therapy at the time of disease onset were at risk of the subsequent development of chronic arthritis. Disease-modifying antirheumatic drug (DMARD) monotherapy was successful in controlling steroid-resistant or steroid-dependent disease in 60% of patients. Methotrexate and cyclosporine showed the best response rates. The combination of high-dose steroids and cyclosporine was administered to successfully control some acute life-threatening complications. Only 6 patients had disease that was both steroid resistant and DMARD resistant. Treatment with biologic agents eventually led to satisfactory control of disease manifestations in 5 (83%) of these 6 patients.Conclusion. Steroids were less effective in patients with chronic articular disease than in those with nonchronic disease. The administration of DMARDs early after disease onset could be beneficial in patients with steroid-resistant disease who are at risk of the development of chronic articular disease. Biologic agents proved to be highly effective in both steroid-resistant and DMARD-resistant AOSD.