最新Juvenile Rheumatoid Arthritis Clinical Overview：幼年型类风湿性关节炎的临床观察-药学医学精品资料.ppt

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1、最新JuvenileRheumatoidArthritisClinicalOverview：幼年型类风湿性关节炎的临床观察-药学医学精品资料AmericanCollegeofRheumatologyCharacteristicsofJRAPauciarticularCoursePolyarticularCourseSystemicDiseaseFrequencyofcases60%30%10%Numberofjointsinvolved45VariableAgeatonsetEarlychildhood;peakat1

2、-3yrsThroughoutchildhood;peakat6-7yrsand8-11yrsThroughoutchildhood;nopeakFemale:maleratio5:13:11:1SystemicinvolvementNotpresentModerateinvolvementProminentTreatmentparadigmPrimarilyNSAIDsorintra-articularcorticosteroidsDMARDsorbiologicswithadjunctiveNSAIDsDMARDs

3、orbiologics;NSAIDsforfeverandpain;corticosteroidsforsystemicfeaturesCassidyandPetty.TextbookofPediatricRheumatology,2005PainisCommonlyReportedinJRALovellandWalco.PediatrClinNorthAm1989;36:1015-27Selfreportofpainfrom462childrenwithJRACincinnatiJuvenileArthritisDat

4、abaseRemissionRatesandFunctioninStudiesUsingACRJRAClassificationCriteriaSteinbrockerIII/IV7-27%SteinbrockerIII/IV<1-7%SteinbrockerIII/IV10%PercentofpatientsinremissionFunctionAdibNetal.Rheumatology2005;44:995-1001CVThromboticAdverseEvents:CARRASurveyChildhoodArthr

5、itisandRheumatologyResearchAlliance(CARRA)98%pediatricrheumatologistsinNorthAmericaSurvey(sponsoredbyCARRA)ConductedpostVioxxwithdrawalDistributedto130pediatricrheumatologistsRequestforinformationregardingfrequencyofvascularcomplicationsinJRApatientsInassociationw

6、ithNSAIDsandCOX-2inhibitorsRequestfornumberofyearsofpracticeResults73%responded(95/130)1546yearsofpracticeinpediatricrheumatology0vasculareventsinJRApopulation1pulmonaryembolismeventreportedforpossiblepsoriaticarthritispatientNSAIDTrialsinJRA:Predating1998Approva

7、lofCelecoxibforAdultsTreatmentsNumberofPatientsStudyDesignSourceTolmetinAspirin10712-weekdouble-blind,parallelgroupLevinsonetal.1977NaproxenAspirin1812-week,randomized,double-blind,crossoverMakela1977NaproxenAspirin238-weekrandomized,double-blind,crossover(two4-w

8、eekperiods)12-monthopen-labelMoranetal.1979NaproxenAspirin8024-weekrandomized,parallelgroup,double-blindKvienetal.1984IbuprofenAspirin9212-week,randomiz