| Objective: The article summarized the clinical features of polyarticular juvenile idiopathic arthritis(PJIA)and compared the efficacy and safety of non-traditional treatments to further improve diagnosis,optimize treatment,and promote disease remission in PJIA patients.Methods: Through retrospective analysis of 67 cases of PJIA patients admitted to Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2013 to December 2018,the clinical manifestations,laboratory indicators and radiological features of different subgroups were summarized,and the mid-long term efficacy and safety of 20 cases of cyclophosphamide treatment group and 16 cases of tocilizumab treatment group were compared and analyzed.Results:(1)Clinical features of PJIA: The ratio of male to female was 1:2.94 in 67 patients with PJIA.The positive to negative ratio of rheumatoid factor(RF)was 1:1.96.The top 3 of active arthritis were ankle joint(62.69%),interphalangeal joint(61.19%)and knee joint(58.21%).The main magnetic resonance changes of the involved joints were hydrocele(84.38%),synovial membrane thickening(68.75%)and bone edema(40.63%).The incidence of bone destruction and soft tissue edema in RF(+)group was higher than that in RF(-)group(P < 0.05).The levels of C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR),as well the positive rate of anti-cyclic citrulline antibody and anti-nuclear antibody in RF(+)group were significantly higher than those in RF negative group(P < 0.05).The overall score of JADAS27 in all patients was 22.98 +6.21,which meant severe disease activity.The levels of CRP,D-dimer and IL-6 were positively correlated with JADAS 27 scores(r = 0.423,P < 0.001;0.439,P < 0.001;0.330,P = 0.020),and RF titers were positively correlated with the positive rate of bone destruction(r = 0.296,P = 0.019).25(OH)VitD was negatively correlated with bone destruction(r=-0.317,P=0.026).Two patients were lost to follow-up after discharge,and the remaining 65 patients were treated with traditional therapy.Among them,30 patients were treated with biological agents at the first time of hospitalization and 9 patients were treated with biological agents after the failure of traditional treatment.Thirty-five cases of disease activity control after treatment with biological agents.(2)Results of mid-long term follow-up of non-traditional treatment: the patients in the tocilizumab group had a longer course of disease and higher disease activity scores than those in the cyclophosphamide group.Comparing the two treatment groups,it was found that the disease activity scores of 1 month,3 months and 6 months of treatment and 1 year of topizumab treatment were significantly decreased,and the difference was statistically significant(P < 0.05).The values of inflammatory markers(CRP and ESR)in different groups after treatment were significantly lower than those before treatment,the difference was statistically significant(P<0.05).The level of interleukin-6 in tocilizumub group was significantly decreased after 6 months and 1 year treatment(P<0.05).In the observation of two groups of drug-related adverse events,41 cases of adverse events occurred,of which 78.05% were in the cyclophosphamide treatment group and 21.95% in the tolizumab group.Among all adverse events,acute upper respiratory infections(29.27%)and aseptic leukocyte urine(24.39%)were the most common.Conclusion: The main clinical features of PJIA include joint swelling and pain and joint destruction,and female patients are predominant in the onset of PJIA.The clinical characteristics of different subgroups are different.The immunosuppressantcy-clophosphamide and emerging biological agent-tocilizumab can alleviate the condition of PJIA patients.Tocilizumab is effective in the treatment of PJIA patients with ineffective tumor necrosis factor-? antagonists,and has good safety and tolerability. |
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