來氟米特循證治療類風濕關節炎1例報告_《中國循證醫學雜志》

作者：

田攀文 ,  吳紅梅 , 王丹琳

四川大學華西醫院老年科（成都 610041）;

關鍵詞：

關節炎，類風濕來氟米特甲氨蝶呤治療

DOI：

10.7507/1672-2531.20080014

視頻：

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目的　了解來氟米特用于類風濕關節炎治療的有效性、安全性和經濟性，為1例類風濕關節炎患者制定治療方案。
方法　計算機檢索ACP Journal Club、Cochrane圖書館（2007年第2期）、MEDLINE（1990～2007.4），查尋來氟米特治療類風濕關節炎的系統評價、臨床隨機對照試驗、隊列研究和病例對照研究等，并對所獲證據進行質量評價，進而應用于本例患者進行臨床治療。
結果　現有A級證據表明，來氟米特可改善關節疼痛、腫脹、患者及醫生總體評價、患者功能殘疾自我評價、血沉、CRP和晨僵時間，其療效和不良反應與甲氨蝶呤相當，但甲氨蝶呤治療總費用較低。對甲氨蝶呤治療無效的患者，來氟米特和甲氨蝶呤聯用可提高療效，并節約成本。結合醫生經驗及患者意愿，對患者采用甲氨蝶呤20mg/周治療6個月后效果不佳，改用來氟米特10mg/d和甲氨蝶呤20mg/周聯合治療3個月后，患者關節腫痛明顯好轉，目前仍在隨訪中。
結論　現有A級證據表明聯用來氟米特和甲氨蝶呤能有效控制類風濕關節炎的關節癥狀。

引用本文： 田攀文,吳紅梅,王丹琳. 來氟米特循證治療類風濕關節炎1例報告. 中國循證醫學雜志, 2008, 08(1): 58-61. doi: 10.7507/1672-2531.20080014 復制

1.	2版. 北京: 人民衛生出版社, 2005. 2548-2557.
2.	American college of rheumatology subcommittee on rheumatoid arthritis guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum, 2002, 46(2): 328-346.
3.	The Evidence-Based Medicine Working Group. Users’ Guides to the Medical Literature: A Mannual for Evidence-Based Clinical Practice. Chicago: AMA Press. 2002.
4.	Phillips B, Ball C, Sackett D, et al. Levels of evidence and grades of recommendation. Available from: URL: http://www.cebm.net/.
5.	Osiri M, Shea B, Robinson V, et al. Leflunomide for treating rheumatoid arthritis. Cochrane Database Syst Rev, 2003,(1): CD002047.
6.	Bao C, Chen S, Gu Y, et al. Leflunomide, a new disease-modifying drug for treating active rheumatoid arthritis in methotrexate-controlled phase II clinical trial. Chin Med J (Engl), 2003, 116(8): 1228-1234.
7.	Kremer JM, Genovese MC, Cannon GW, et al. Concomitant leflunomide therapy in patients with active rheumatoid arthritis despite stable doses of methotrexate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med, 2002, 137(9): 726-733.
8.	Kremer JM, Genovese MC, Cannon GW, et al. Combination leflunomide and methotrexate (MTX) therapy for patients with active rheumatoid arthritis failing MTX monotherapy: open-label extension of a randomized, double-blind, placebo controlled trial. J Rheumatol, 2004, 31(8): 1521-1531.
9.	Kuzmanova SI, Solakov PT, Batalov AZ, et al. Leflunomide in the treatment of refractory rheumatoid arthritis. Folia Med (Plovdiv), 2003, 45(3): 43-47.
10.	Maetzel A, Strand V, Tugwell P, et al. Economic comparison of leflunomide and methotrexate in patients with rheumatoid arthritis: an evaluation based on a 1-year randomized controlled trial. Pharmacoeconomics, 2002, 20(1): 61-70.
11.	Schadlich PK, Zeidler H, Zink A, et al. Modelling cost effectiveness and cost utility of sequential DMARD therapy including leflunomide in rheumatoid arthritis in Germany: I. Selected DMARDs and patient-related costs. Pharmacoeconomics, 2005, 23(4): 377-393.
12.	Schadlich PK, Zeidler H, Zink A, et al. Modelling cost effectiveness and cost utility of sequential DMARD therapy including leflunomide for rheumatoid arthritis in Germany: II. The contribution of leflunomide to efficiency. Pharmacoeconomics, 2005, 23(4): 395-420.

1. 2版. 北京: 人民衛生出版社, 2005. 2548-2557.
2. American college of rheumatology subcommittee on rheumatoid arthritis guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum, 2002, 46(2): 328-346.
3. The Evidence-Based Medicine Working Group. Users’ Guides to the Medical Literature: A Mannual for Evidence-Based Clinical Practice. Chicago: AMA Press. 2002.
4. Phillips B, Ball C, Sackett D, et al. Levels of evidence and grades of recommendation. Available from: URL: http://www.cebm.net/.
5. Osiri M, Shea B, Robinson V, et al. Leflunomide for treating rheumatoid arthritis. Cochrane Database Syst Rev, 2003,(1): CD002047.
6. Bao C, Chen S, Gu Y, et al. Leflunomide, a new disease-modifying drug for treating active rheumatoid arthritis in methotrexate-controlled phase II clinical trial. Chin Med J (Engl), 2003, 116(8): 1228-1234.
7. Kremer JM, Genovese MC, Cannon GW, et al. Concomitant leflunomide therapy in patients with active rheumatoid arthritis despite stable doses of methotrexate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med, 2002, 137(9): 726-733.
8. Kremer JM, Genovese MC, Cannon GW, et al. Combination leflunomide and methotrexate (MTX) therapy for patients with active rheumatoid arthritis failing MTX monotherapy: open-label extension of a randomized, double-blind, placebo controlled trial. J Rheumatol, 2004, 31(8): 1521-1531.
9. Kuzmanova SI, Solakov PT, Batalov AZ, et al. Leflunomide in the treatment of refractory rheumatoid arthritis. Folia Med (Plovdiv), 2003, 45(3): 43-47.
10. Maetzel A, Strand V, Tugwell P, et al. Economic comparison of leflunomide and methotrexate in patients with rheumatoid arthritis: an evaluation based on a 1-year randomized controlled trial. Pharmacoeconomics, 2002, 20(1): 61-70.
11. Schadlich PK, Zeidler H, Zink A, et al. Modelling cost effectiveness and cost utility of sequential DMARD therapy including leflunomide in rheumatoid arthritis in Germany: I. Selected DMARDs and patient-related costs. Pharmacoeconomics, 2005, 23(4): 377-393.
12. Schadlich PK, Zeidler H, Zink A, et al. Modelling cost effectiveness and cost utility of sequential DMARD therapy including leflunomide for rheumatoid arthritis in Germany: II. The contribution of leflunomide to efficiency. Pharmacoeconomics, 2005, 23(4): 395-420.

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來氟米特循證治療類風濕關節炎1例報告

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《中國循證醫學雜志》

來氟米特循證治療類風濕關節炎1例報告

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