title: Treatment of refractory juvenile idiopathic arthritis via pulse therapy using methylprednisolone and cyclophosphamide.
abstract: BACKGROUND
  Patients with refractory juvenile idiopathic arthritis can benefit from aggressive therapy.
  
  
  METHODS
  We followed the clinical course of 4 patients (2 male, 2 female) aged 9.1-17.8 years (mean of 14.5 years) with polyarticular onset of juvenile rheumatoid arthritis and one 16-year-old boy with juvenile spondyloarthropathy associated with inflammatory bowel disease. All the juvenile rheumatoid arthritis patients fulfilled the diagnostic criteria established by the American College of Rheumatology. All patients had unremitting arthritis despite maximum therapy. All patients began receiving treatment using intravenous cyclophosphamide at 500-750 mg/m  and intravenous methylprednisolone at 30 mg/kg, for 3 days monthly (1 g maximum). The patients received between 3 and 11 monthly treatments, and/or 3-5 treatments every two months for 12 months, according to the severity of the disease and/or response to the therapy. All but one patient were evaluated retrospectively at the start (time 0) and 6 months (time 1), and 12 months (time 2) after the beginning of the treatment. A rapid and clinically significant suppression of systemic and articular manifestations was seen in all patients. Our results showed the favorable effect of this treatment on the clinical and some laboratory manifestations of juvenile idiopathic arthritis.
authors.affiliation: Clinical Immunology and Rheumatology, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Tania Caroline Monteiro
authors.initials: TC
authors.lastname: de Castro
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Terreri
authors.forename: Claudio
authors.initials: C
authors.lastname: Len
authors.forename: Maria Odete Esteves
authors.initials: MO
authors.lastname: Hilário
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008775:Methylprednisolone / Q000008:administration & dosage*; D020551:Pulse Therapy, Drug; D025242:Spondylarthropathies / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D003520:Cyclophosphamide; D008775:Methylprednisolone; D008727:Methotrexate