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【medical-news】侵袭性激素疗法与标准疗法治疗青
http://www.medscape.com/viewarticle/579437
NEW YORK (Reuters Health) Aug 21 - Aggressive corticosteroid therapy does not differ from standard therapy in improving outcomes of patients with juvenile dermatomyositis, according to findings published in the July 15th issue of Arthritis and Rheumatism (Arthritis Care and Research).
"Preliminary data suggest that early aggressive therapy may lead to a more favorable outcome for patients with juvenile dermatomyositis," Dr. Lauren M. Pachman, of Northwestern University, Chicago, and colleagues write.
To further investigate, the researchers compared 36-month outcomes of 42 patients who received aggressive therapy matched to 42 who received standard therapy. The patients were well matched based on propensity scores.
There were no differences between the aggressive therapy group and the standard therapy group in age at onset, sex, race, and duration of untreated disease. Initial Disease Activity scores for weakness and range of motion were significant predictors of the therapy chosen.
Aggressive therapy was defined as intravenous methylprednisolone 30 mg/kg per day or oral prednisone 5 to 30 mg/kg per day. Standard therapy was defined as corticosteroids 1 to 2 mg/kg per day. Patients who received aggressive therapy were more ill at diagnosis.
"Children with juvenile dermatomyositis do better overall when they come to early diagnosis and therapy," Dr. Pachman said in an interview with Reuters Health. "For the whole group we need to develop better therapy," she explained.
"At 36 months after start of therapy, over 30% of children had loss of range of motion, 26% had ongoing muscle inflammation, and over 50% still had active skin inflammation which is associated with the development of calcifications," she noted. "Twenty-seven percent of the children had calcifications during the course of their illness."
No significant differences in outcomes were observed in the matched pairs. Prescription of methotrexate and duration of untreated disease were associated with range of motion loss. Calcification and hydroxychloroquine were associated with persistent rash, and lactate dehydrogenase and age at onset were associated with weakness. Duration of untreated disease predicted calcification.
"Understanding the pathways of inflammation in the child with juvenile dermatomyositis at diagnosis may lead to more effective therapy and better outcomes for children with this often devastating autoimmune disease" Dr. Pachman said. "Funding is needed to continue these studies by skilled clinical investigators and collaborating pediatric rheumatologists."
Arthritis Rheum 2008;59:989-995. [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-03-09 17:14
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