tailieunhanh - Evidence based pediatrics - part 9

Hiện nay, cấp I bằng chứng từ một RCT nhỏ sulfasalazine là hiệu quả hơn giả dược trong điều trị của Khoảng một nửa những đứa trẻ dùng sulfasalazine (trong nghiên cứu này, bệnh nhân có polyarticular và oligoarticular JA) cho thấy phản ứng trong một số tính năng quan trọng của bệnh, | Musculoskeletal Disorders 369 Sulfasalazine sulfasalazine is widely used as a DMARD in the treatment of adult RA. There is now level I evidence from a small RCT that sulfasalazine is more effective than placebo in the treatment of About half those children taking sulfasalazine in this study the patients had polyarticular and oligoarticular JA showed a response in a number of important disease features compared with about 25 percent in the placebo group. However sulfasalazine was associated with frequent side effects. Sulfasalazine gets a grade B recommendation as a DMARD for JA. Gold intramuscular gold was once commonly used in the treatment of childhood arthritis. It is associated however with a high toxicity rate. Because of the availability of more effective and safer alternatives for example methotrexate gold is now rarely used in children. There is level I evidence that the oral preparation of gold auranofin has no effect in treating Therefore intramuscular gold gets a grade C recommendation while oral gold gets a grade E recommendation. Hydroxychloroquine there is level I evidence that suggests that the response of children with JA to hydroxychloroquine is unlikely to be clinically Hydroxychloroquine however has recently been widely used in combination with other DMARDs in the therapy of adult RA. There may be an as yet undefined role for hydroxychloroquine as part of combination therapy for JA. Hydroxychloroquine gets a grade D recommendation as monotherapy and a grade C recommendation as part of combination therapy. Azathioprine azathioprine is a potentially cytotoxic agent that is rarely used in JA. There is level I evidence from a small study of 32 subjects with severe JA that the toxicity of azathioprine outweighs its benefit. Therefore azathioprine gets a grade D Cyclosporine because there is still a sizeable minority of children with JA who do not respond to methotrexate many other agents that can .