Rheumatoid Arthritis Clinical Overview幼年型类风湿性关节炎的临床观察课件.pptVIP

Juvenile Rheumatoid Arthritis Clinical Overview Daniel J. Lovell MD, MPH Levinson Professor of Pediatrics Division of Rheumatology Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio, USA American College of Rheumatology Characteristics of JRA Pain is Commonly Reported in JRA Functional Impact of Pain in Children with JRA Parent’s assessment of activities affected by child’s pain 22% pauciarticular course 48% polyarticular course 26% systemic onset Articular Erosions in JRA Patients Outcome Following Onset of JRA Systematic review of published outcome data in JIA, JCA, JRA 21 studies published over 10-year period 19 retrospective studies; 2 prospective Follow up varied 5 years in 4 studies 10 years in 14 studies Study sizes varied: 44 – 1082 patients 10 studies 200 patients Total n = 5342 patients Remission Rates and Function in Studies Using ACR JRA Classification Criteria CV Thrombotic Adverse Events: CARRA Survey Childhood Arthritis and Rheumatology Research Alliance (CARRA) 98% pediatric rheumatologists in North America Survey (sponsored by CARRA) Conducted post Vioxx withdrawal Distributed to 130 pediatric rheumatologists Request for information regarding frequency of vascular complications in JRA patients In association with NSAIDs and COX-2 inhibitors Request for number of years of practice Results 73% responded (95/130) 1546 years of practice in pediatric rheumatology 0 vascular events in JRA population 1 pulmonary embolism event reported for possible psoriatic arthritis patient NSAID Trials in JRA: Predating 1998 Approval of Celecoxib for Adults NSAID Trials in JRA: Subsequent to 1998 Approval of Celecoxib for Adults American College of Rheumatology (ACR) Pediatric 30 Response ACR Pediatric 30 Response Criterion: ≥ 30% improvement in any 3 of 6 core set measures with no more than 1 of the remaining measures worsening by  30%. Meloxicam vs Naproxen in JRA Meloxicam vs Naproxen in JRA Comparison of ACR Pediatric 30 Response Rates with