Methotrexate for treating juvenile idiopathic arthritis

  • Review
  • Intervention

Authors

  • Tim Takken,

    Corresponding author
    1. University Medical Center Utrecht, Department of Pediatric Physical Therapy & Exercise Physiology, Utrecht, Netherlands
    • Tim Takken, Department of Pediatric Physical Therapy & Exercise Physiology, University Medical Center Utrecht, Room Kb 02.056.0, POBox 85090, Utrecht, 3508 AB, Netherlands. t.takken@umcutrecht.nl.

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  • Janjaap J van der Net,

    1. University Medical Center Utrecht, Department of Pediatric Physical Therapy & Exercise Physiology, Utrecht, Netherlands
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  • Paul PJM Helders

    1. University Medical Center Utrecht, Department of Pediatric Physical Therapy & Exercise Physiology, Utrecht, Netherlands
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Abstract

Background

In both adult rheumatoid arthritis (RA) and juvenile arthritis, the focus has shifted from 'inflammation parameters' to more patient centered disability outcomes. In RA this resulted in the development of the Outcome Measures in Arthritis Clinical Trials (OMERACT), and in juvenile arthritis the Pediatric Rheumatology International Trials Organization (PRINTO) core set. This PRINTO-core set was established using a combination of statistical and consensus formation techniques. This core set contains a number of patient centered disability measures. This review systematically searched the available literature and reports the available evidence of efficacy of MTX, with special focus on patient centered disability measures in Juvenile Idiopathic Arthritis (JIA).

Objectives

To perform a systematic review on the effects of MTX on functional ability, range of motion, quality of life, overall well-being and pain for patients with JIA.

Search methods

The Cochrane Controlled Trials Register (CCTR) and MEDLINE were searched up to March 2001, using the search strategy sensitive for randomised controlled trials, used by the Cochrane Collaboration.

Selection criteria

Randomized controlled trials and controlled clinical trials comparing MTX against placebo or standard care in patients with Juvenile Idiopathic Arthritis (JIA) were selected.

Data collection and analysis

Two reviewers (TT, JN) determined the studies to be included in this review and extracted the data of patient centered disability measures. The data were pooled using standardized mean differences (SMD) for limited joint range score, number of joints with swelling. The number of joints with pain on motion were evaluated using weighted mean differences (WMD). Physicians global assessment, parents global assessment and withdrawals due to efficacy and side effects were evaluated with pooled odds ratios (OR).

Main results

Only two studies with a total 165 JIA patients under 18 years of age were included in this review. For JIA patients, MTX therapy had small to moderate effects on patient centered disability outcomes. The effect on joint range of motion, number of joints with pain and swelling and physician's and parent's assessment of disease activity showed a relative percentage improvement from 3 to 23% greater with MTX than with placebo.

Authors' conclusions

Current evidence suggests that MTX does have minimal clinically significant effects (>20%) on patient centered disability measures in JIA patients.

摘要

背景

Methotrexate治療特發性幼年型類風濕性關節炎

在成年及幼年RA病患中其注目焦點已由引起發炎的因素轉移到病患障礙恢復程度。成年及幼年型類風濕性關節炎之障礙結果評估分別為Outcome Measures in Arthritis Clinical Trials (OMERACT)及Pediatric Rheumatology International Trials Organization (PRINTO)核心項目。PRINTO核心項目合併使用統計及共識形成技術。這核心項目含有病患為中心之障礙測量。本回顧研究Methotrexate治療幼年型類風濕性關節炎病患為中心之障礙測量。

目標

本研究回顧Methotrexate治療幼年型類風濕性關節炎在關節功能、活動度、生活品質、整體感覺及疼痛之效果。

搜尋策略

搜尋包括Cochrane Controlled Trials Register (CCTR) and MEDLINE (直到2001年3月)。

選擇標準

所有比較Methotrexate治療與安慰劑或標準治療之隨機對照試驗研究及對照試驗研究。

資料收集與分析

兩位作者獨立進行資料摘錄。針對關節活動受限分數,腫脹關節數結果,計算標準化平均差異(standardized mean difference, SMD)。針對活動時疼痛關節數,計算加權平均差異(weighted mean difference, WMD)。針對醫師整體評估、病患整體評估、及因無效或副作用退出,計算勝算比(odds ratios, OR)。

主要結論

2篇臨床試驗(165位患者)符合納入標準。Methotrexate治療對病患為中心之障礙測量有小到中等效用。在關節活動受限,腫脹關節數,活動時疼痛關節數,醫師整體評估、病患整體評估方面Methotrexate比安慰劑進步3 to 23% 。

作者結論

Methotrexate治療幼年型類風濕性關節炎對病患為中心之障礙測量有小的臨床效用(>20%)。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

Methotrexate(MTX)是一種常用的免疫調整藥物來治療兒童少年性關節炎。據認為,Methotrexate是一種有效的藥物來治療兒童少年性關節炎。我們回顧了現有文獻Methotrexate對以病人為中心的殘疾測量。兩項試驗被發現且結果加以匯集。我們發現Methotrexate有小到中度的效果。比起安慰劑組,MTX組有 3 – 23%的改善。然而,大多數的效果太小,在臨床上不具有重要意義。

Plain language summary

Methotrexate for juvenile idiopathic arthritis

Methotrexate (MTX) is a commonly used immuno modifying drug for children with juvenile arthritis. It is believed that MTX is an effective medication for children with juvenile arthritis. We reviewed the existing literature on the efficacy of MTX on patient centered disability measures. Two trials were found and the results were pooled. We found small to moderate effects of MTX. These effects ranged from 3 to 23% greater improvement in the MTX group than the placebo group. However, most of these effects were too small to be clinically significant.

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