Penicillamine and Hydroxychloroquine in the Treatment of Severe Juvenile Rheumatoid Arthritis
One hundred sixty-two children with severe juvenile rheumatoid arthritis were entered in a randomized, double-blind, placebo-controlled 12-month clinical trial designed to establish the efficacy and safety of two slower-acting antirheumatic drugs, penicillamine and hydroxychloroquine. The study was...
Gespeichert in:
Veröffentlicht in: | The New England journal of medicine 1986-05, Vol.314 (20), p.1269-1276 |
---|---|
Hauptverfasser: | , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
Zusammenfassung: | One hundred sixty-two children with severe juvenile rheumatoid arthritis were entered in a randomized, double-blind, placebo-controlled 12-month clinical trial designed to establish the efficacy and safety of two slower-acting antirheumatic drugs, penicillamine and hydroxychloroquine. The study was a cooperative effort of the United States and the Soviet Union. One group of subjects received 10 mg of penicillamine per kilogram of body weight per day, another group received 6 mg of hydroxychloroquine per kilogram daily, and a third group received placebo. All three groups were allowed a single concurrent nonsteroidal antiinflammatory drug, but no other antirheumatic medications, including corticosteroids.
All three groups had dramatic improvement in many of the clinical and laboratory outcome variables after one year of study. There were no significant differences in efficacy between the penicillamine and placebo groups. Pain on movement was the only index of articular disease that was alleviated more by hydroxychloroquine than by placebo. Serious adverse drug reactions attributable to the active agents were rare.
We were unable to demonstrate that, in the presence of a nonsteroidal antiinflammatory drug, either penicillamine or hydroxychloroquine is superior to placebo in the treatment of children with juvenile rheumatoid arthritis. (N Engl J Med 1986; 314:1269–76.)
JUVENILE rheumatoid arthritis is the most common of the pediatric rheumatic diseases,
1
with an annual incidence of about 1.4 cases per 10,000 children and a prevalence of 0.5 to 1 case per 1000 in the United States.
2
,
3
Three distinct types of the illness are recognized: systemic, which is characterized by intermittent fever (>39.4°C), the typical rheumatoid rash, and arthritis; polyarticular, in which five or more joints are affected with arthritis without systemic manifestations; and pauciarticular, in which arthritis alone is present in four or fewer joints.
4
,
5
Initial pharmacologic management of newly diagnosed cases typically includes the use of nonsteroidal antiinflammatory . . . |
---|---|
ISSN: | 0028-4793 1533-4406 |
DOI: | 10.1056/NEJM198605153142001 |