rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2001-396rsp-534Research ArticleСтатьиArticlesТЕРАПИЯ РЕФРАКТЕРНОГО ЮВЕНИЛЬНОГО ХРОНИЧЕСКОГО АРТРИТАTHERAPY OF R EFRACTOR Y JUVENILE CHRONIC ARTHRITISMichelsHMichelsH-200115042001392№2 (2001)3136Copyright © Michels H., 20012001Michels H.Michels H.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/534

Резюме В лекции представлены современные аспекты лечения рефрактерной формы ювенильного хронического артрита (ЮХА), Обсуждена терапия ЮХА высокими дозами парентерального метотрексата; освещена тактика комбинированного использования болезнь-модифицирующих средств; представлена эффективность "новых" цитотоксических препаратов, внутривенного иммуноглобулина, а также антиципюкиновая терапия и аутогенная трансплантация стволовых клеток.

Summary Up-to-date aspects of treatment of refractory form of juvenile chronic arthritis (JCA) is presented. JCA therapy by high doses of parenteral Methotrexate, tactics of combined using of disease modifying drugs, efficacy of «new» cytotoxic drugs, intravenous immunoglobulin and anticytokine therapy and autologous stem cel! transplantation were presented.

терапиярефрактерный ЮХАtherapyrefractory JCAReferences<div><p>Truchenbrodt Н., Hafner R. Methotrexate therapy in juvenile rheumatoid arthritis: a retrospective study. Arthr. R heum,, 1986. 29, 801-807.</p><p>Giannini E.H. Brewer E.J., Kuzmina N.N., Shaikov A., Maximov A., Vorontsov I., Fink C.W., Newman A.J., Cassidy J.T., Zcmel L.S., for the Pediatric Rheumatology Collaborative Study Group and the Cooperative Children's Study Group. Methotrexate in resistant juvenile rheumatoid arthritis. Results of the U.S.A.-U.S.S.A. double-blind, placebo-controlled trial. N. Engl. J. Med., 1992, 326, 1043-1049.</p><p>Singscn B.H. Juvenile rheumatoid arthritis and the pediatric spondylarthropalics. In: Wcisman M.H., Weinblalt M.E., Louie J.S, eds. Treatment of the Rheumatic Diseases. 2IK| Ed. Philadelphia. W.B. Saunders Company, 2000, 403-422.</p><p>Shaikov A., Maximov A„ Speranskij A.I., Lovell D.J., Giannini E.H., Solovyev S.K. Repetitive use of pulse therapy with methylprednisolone and cyclophosphamide in addition to oral methotrexate in children with systemic juvenile rheumatoid arthritis - preliminary results of a long-term study. J. Rheumat., 1992. 19. 612-616.</p><p>lob-Deslandre C., Chkirate B. Treatment of refractory juvenile systemic arthritis with cyclosporin A and methotrexate: an open study of 5 patients. Ann. Rheum. Dis. 2000, 59. 744 /Abstract/.</p><p>Cassidy J.T., Petty R.E. Textbook of Pediatric Rheumatology. 3"[2] EiL Philadelphia. W.B. Saunders Company, 1995, 197.</p><p>Wilske K.R., Healy L.A. Challenging the therapeutic pyramid: a new look al. treatment strategies for rheumatoid arthritis. J, Rheumat., 1990. 17. /suppl.25/. 47.</p><p>Fries J.F. Reevaluating the therapeutic approach to rheamaloid arthritis: the «sawtooth» strategy. J. Rheumatol., 1990, 17, 1-15.</p><p>Walton R.C., Nussenblatt R.B. Whitcup S.M, Cyclosporin therapy for severe sight-threatening uveitis in children and adolescents. Ophthalmol., 1998, 105, 2028-2034.</p><p>Vougiouka O. Demetriou L., Vlahou C., Liotsou A., Kyrzopoulos D. Cyclosporine A treatment in chronic recurrent uveitis in JIA. Ann, Rheum. Dis., 2000. 59, 740.</p><p>Tugwell P. Pincus Т., Yocum D., Stein М., Gluck O., Kraag G. , McKendry R., Tesser J., Baker P. Wells G. Combination therapy with cyclosporine and methotrexate in severe rheumatoid arthritis. N. Engl. J. Med., 1995, 333, 137-141,</p><p>Hardman J.G. Limbird L.E., Molinoff P.B., Ruddon R.W. Gilman A.G. Goodman Gilman’s. The Pharmacological Basis of Therapeutics 9,k Ed New York McGraw-Hill, 1996, 12991300.</p><p>Modesto C„ Borona М. Marsal S., Amal-Guimera C. FK-506 /tacrolimus/ treatment in severe JIA. Ann. Rheum. Dis., 2000, 59, 740-741.</p><p>Fox R.I., Herrmann M.L., Frangou C.G., Wahl G.M., Morris R.E., Kirschbaum B.J. How docs leflunomidc modulate the immune response in rheumatoid arthritis? Bio. Drugs, 1999, 12. 301-315.</p><p>Groothoff J.W„ van Lecuwcn E.F. High dose intravenous gammaglobulines in chronic systemic arthritis. Br. Med. J. 1988, 296, 1362-1363.</p><p>Prieur A.M., AdlelT A., Debre M„ Boulate P., Griscelli C. High dose immunoglobulin therapy in severe JCA. Long-term follow-up in 16 patients. Clin. Exp. Rheumat., 1990, 8, 603-608.</p><p>Shaikov A.V. Kuznetsova l.O., Movsisian G.R. Intravenous immunoglobulin in combined therapy for children with juvenile rheumatoid arthritis. Vcstn. Ross. Akad. Med. Nauk. 1999. 12,36-39.</p><p>Giannini E.H., Lovell D.J., Silverman E.D., Sundel R.P., Tague B.L., Ruperlo N. Intravenous immunoglobulin in the treatment of polyarticular juvenile rheumatoid arthritis: a phase 1-2 study. Pediatric Collaborative Study Group. J. Rheumatol., 1996, 23. 919-924.</p><p>Uziel Y., Laxer R.M., Schneider E.D. Intravenous immunoglobulin therapy in systemic onset juvenile rheumatoid arthritis: a follow-up study. J. Rheumatol., 1996, 5, 910-918.</p><p>Lovell D.J., Giannini E.H., Reifl' A., Cawkwell G.D., Silverman E.D., Nocton J.J., Stein L.D., Gedalia A. Ilowite N.T. Wallace C. A., Whitmore J. Finck В.K, Etanercepl in children with polyarticular juvenile rheumatoid artritis. N. Engl. J. Med., 2000, 342, 763-769.</p><p>Kiren V„ Lepore L., Tommasini A. Treatment with etanercepl in intractable juvenile idiopathic arthritis. Ann. Rheum. Dis., 2000, 59, 742.</p><p>Haapasaari J., Kautiainen H., Leirisalo-Repo M. Etanercepl in the treatment of juvenile idiopatic arthritis. Ann. Rheum. Dis., 2000, 59, 743.</p><p>Prieur A.M., Mouy R., Debre М., Quarlier P Enbrel I etanercepl/ in JIA. Ann.Rheum.Dis. 2000; 59: 745-746.</p><p>Kimura Y., Li S., Imundo L. Use of etanercepl in the treatment of systemic JIA in the USA: results of a survey. Ann. Rheum. Dis., 2000, 59, 741,</p><p>Vinje O., Obiora, Forre O. Juvenile chronic polyarthritis treated with infliximab. Ann. Rheum. Dis., 2000, 59, 745.</p><p>Gerloni V„ Pontikaki I., Dcsiati F. Gattinara М., Fantini F. Infliximab in the treatment of persistently active refractory JIA: a short-term pilot study. Arthritis Rheum., 2000, 43, 256.</p><p>Lahdenne P., Honkancn V. Infliximab vs ctanercept in the treatment of severe JCA. Arthritis Rheum. 2000. 43. 3SI.</p><p>Wulffraat N.M., Brinkman D., Prieur A.M. Autologous stem cell transplantation for refractory JIA. J. Rheumatol., 2000, 59. (suppl.3), 13.</p></div><br /><div><p>Truchenbrodt Н., Hafner R. Methotrexate therapy in juvenile rheumatoid arthritis: a retrospective study. Arthr. R heum,, 1986. 29, 801-807.</p><p>Giannini E.H. Brewer E.J., Kuzmina N.N., Shaikov A., Maximov A., Vorontsov I., Fink C.W., Newman A.J., Cassidy J.T., Zcmel L.S., for the Pediatric Rheumatology Collaborative Study Group and the Cooperative Children's Study Group. Methotrexate in resistant juvenile rheumatoid arthritis. Results of the U.S.A.-U.S.S.A. double-blind, placebo-controlled trial. N. Engl. J. Med., 1992, 326, 1043-1049.</p><p>Singscn B.H. Juvenile rheumatoid arthritis and the pediatric spondylarthropalics. In: Wcisman M.H., Weinblalt M.E., Louie J.S, eds. Treatment of the Rheumatic Diseases. 2IK| Ed. Philadelphia. W.B. Saunders Company, 2000, 403-422.</p><p>Shaikov A., Maximov A„ Speranskij A.I., Lovell D.J., Giannini E.H., Solovyev S.K. Repetitive use of pulse therapy with methylprednisolone and cyclophosphamide in addition to oral methotrexate in children with systemic juvenile rheumatoid arthritis - preliminary results of a long-term study. J. Rheumat., 1992. 19. 612-616.</p><p>lob-Deslandre C., Chkirate B. Treatment of refractory juvenile systemic arthritis with cyclosporin A and methotrexate: an open study of 5 patients. Ann. Rheum. Dis. 2000, 59. 744 /Abstract/.</p><p>Cassidy J.T., Petty R.E. Textbook of Pediatric Rheumatology. 3"[2] EiL Philadelphia. W.B. Saunders Company, 1995, 197.</p><p>Wilske K.R., Healy L.A. Challenging the therapeutic pyramid: a new look al. treatment strategies for rheumatoid arthritis. J, Rheumat., 1990. 17. /suppl.25/. 47.</p><p>Fries J.F. Reevaluating the therapeutic approach to rheamaloid arthritis: the «sawtooth» strategy. J. Rheumatol., 1990, 17, 1-15.</p><p>Walton R.C., Nussenblatt R.B. Whitcup S.M, Cyclosporin therapy for severe sight-threatening uveitis in children and adolescents. Ophthalmol., 1998, 105, 2028-2034.</p><p>Vougiouka O. Demetriou L., Vlahou C., Liotsou A., Kyrzopoulos D. Cyclosporine A treatment in chronic recurrent uveitis in JIA. Ann, Rheum. Dis., 2000. 59, 740.</p><p>Tugwell P. Pincus Т., Yocum D., Stein М., Gluck O., Kraag G. , McKendry R., Tesser J., Baker P. Wells G. Combination therapy with cyclosporine and methotrexate in severe rheumatoid arthritis. N. Engl. J. Med., 1995, 333, 137-141,</p><p>Hardman J.G. Limbird L.E., Molinoff P.B., Ruddon R.W. Gilman A.G. Goodman Gilman’s. The Pharmacological Basis of Therapeutics 9,k Ed New York McGraw-Hill, 1996, 12991300.</p><p>Modesto C„ Borona М. Marsal S., Amal-Guimera C. FK-506 /tacrolimus/ treatment in severe JIA. Ann. Rheum. Dis., 2000, 59, 740-741.</p><p>Fox R.I., Herrmann M.L., Frangou C.G., Wahl G.M., Morris R.E., Kirschbaum B.J. How docs leflunomidc modulate the immune response in rheumatoid arthritis? Bio. Drugs, 1999, 12. 301-315.</p><p>Groothoff J.W„ van Lecuwcn E.F. High dose intravenous gammaglobulines in chronic systemic arthritis. Br. Med. J. 1988, 296, 1362-1363.</p><p>Prieur A.M., AdlelT A., Debre M„ Boulate P., Griscelli C. High dose immunoglobulin therapy in severe JCA. Long-term follow-up in 16 patients. Clin. Exp. Rheumat., 1990, 8, 603-608.</p><p>Shaikov A.V. Kuznetsova l.O., Movsisian G.R. Intravenous immunoglobulin in combined therapy for children with juvenile rheumatoid arthritis. Vcstn. Ross. Akad. Med. Nauk. 1999. 12,36-39.</p><p>Giannini E.H., Lovell D.J., Silverman E.D., Sundel R.P., Tague B.L., Ruperlo N. Intravenous immunoglobulin in the treatment of polyarticular juvenile rheumatoid arthritis: a phase 1-2 study. Pediatric Collaborative Study Group. J. Rheumatol., 1996, 23. 919-924.</p><p>Uziel Y., Laxer R.M., Schneider E.D. Intravenous immunoglobulin therapy in systemic onset juvenile rheumatoid arthritis: a follow-up study. J. Rheumatol., 1996, 5, 910-918.</p><p>Lovell D.J., Giannini E.H., Reifl' A., Cawkwell G.D., Silverman E.D., Nocton J.J., Stein L.D., Gedalia A. Ilowite N.T. Wallace C. A., Whitmore J. Finck В.K, Etanercepl in children with polyarticular juvenile rheumatoid artritis. N. Engl. J. Med., 2000, 342, 763-769.</p><p>Kiren V„ Lepore L., Tommasini A. Treatment with etanercepl in intractable juvenile idiopathic arthritis. Ann. Rheum. Dis., 2000, 59, 742.</p><p>Haapasaari J., Kautiainen H., Leirisalo-Repo M. Etanercepl in the treatment of juvenile idiopatic arthritis. Ann. Rheum. Dis., 2000, 59, 743.</p><p>Prieur A.M., Mouy R., Debre М., Quarlier P Enbrel I etanercepl/ in JIA. Ann.Rheum.Dis. 2000; 59: 745-746.</p><p>Kimura Y., Li S., Imundo L. Use of etanercepl in the treatment of systemic JIA in the USA: results of a survey. Ann. Rheum. Dis., 2000, 59, 741,</p><p>Vinje O., Obiora, Forre O. Juvenile chronic polyarthritis treated with infliximab. Ann. Rheum. Dis., 2000, 59, 745.</p><p>Gerloni V„ Pontikaki I., Dcsiati F. Gattinara М., Fantini F. Infliximab in the treatment of persistently active refractory JIA: a short-term pilot study. Arthritis Rheum., 2000, 43, 256.</p><p>Lahdenne P., Honkancn V. Infliximab vs ctanercept in the treatment of severe JCA. Arthritis Rheum. 2000. 43. 3SI.</p><p>Wulffraat N.M., Brinkman D., Prieur A.M. Autologous stem cell transplantation for refractory JIA. J. Rheumatol., 2000, 59. (suppl.3), 13.</p></div><br />

The authors declare that there are no conflicts of interest present.