来氟米特循证治疗类风湿关节炎1例报告_《中国循证医学杂志》

作者：

田攀文 ,  吴红梅 , 王丹琳

四川大学华西医院老年科（成都 610041）;

关键词：

关节炎，类风湿来氟米特甲氨蝶呤治疗

DOI：

10.7507/1672-2531.20080014

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　了解来氟米特用于类风湿关节炎治疗的有效性、安全性和经济性，为1例类风湿关节炎患者制定治疗方案。
方法　计算机检索ACP Journal Club、Cochrane图书馆（2007年第2期）、MEDLINE（1990～2007.4），查寻来氟米特治疗类风湿关节炎的系统评价、临床随机对照试验、队列研究和病例对照研究等，并对所获证据进行质量评价，进而应用于本例患者进行临床治疗。
结果　现有A级证据表明，来氟米特可改善关节疼痛、肿胀、患者及医生总体评价、患者功能残疾自我评价、血沉、CRP和晨僵时间，其疗效和不良反应与甲氨蝶呤相当，但甲氨蝶呤治疗总费用较低。对甲氨蝶呤治疗无效的患者，来氟米特和甲氨蝶呤联用可提高疗效，并节约成本。结合医生经验及患者意愿，对患者采用甲氨蝶呤20mg/周治疗6个月后效果不佳，改用来氟米特10mg/d和甲氨蝶呤20mg/周联合治疗3个月后，患者关节肿痛明显好转，目前仍在随访中。
结论　现有A级证据表明联用来氟米特和甲氨蝶呤能有效控制类风湿关节炎的关节症状。

引用本文： 田攀文,吴红梅,王丹琳. 来氟米特循证治疗类风湿关节炎1例报告. 中国循证医学杂志, 2008, 08(1): 58-61. doi: 10.7507/1672-2531.20080014 复制

1.	2版. 北京: 人民卫生出版社, 2005. 2548-2557.
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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: 人民卫生出版社, 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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来氟米特循证治疗类风湿关节炎1例报告

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《中国循证医学杂志》

来氟米特循证治疗类风湿关节炎1例报告

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