title: Sequential changes to clinical parameters and adhesion molecules following intravenous pulse cyclophosphamide and methylprednisolone treatment of refractory juvenile idiopathic arthritis.
abstract: It is believed that the systemic subtype and the positive rheumatoid factor, polyarticular subtype of juvenile idiopathic arthritis (JIA) show the least favorable outcomes for therapy; patients with systemic JIA are often resistant to recommended therapeutic modalities. We report the sequential changes to clinical and laboratory findings from pulse therapy with monthly intravenous cyclophosphamide (0.5 g/m2 body surface area) administration combined with methylprednisolone (30 mg/kg; 1 gm maximum) for 6 months, following which the medication interval was elongated to 3 months for a total of from 7 to 12 courses. Among 4 children suffering from refractory systemic JIA, 3 demonstrated clinical improvement, 2 of whom achieved clinical remission. Furthermore, we also adminstered this therapy to a girl suffering from refractory polyarticular JIA, following which she revealed clinical remission subsequent to 9 courses of such therapy. From our experience, we suggest that patients afflicted with JIA that is unresponsive to traditional medication may experience benefit from this type of pulse therapy.
authors.affiliation: Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan.
authors.forename: C Y
authors.initials: CY
authors.lastname: Chen
authors.forename: L C
authors.initials: LC
authors.lastname: Chen
authors.forename: K W
authors.initials: KW
authors.lastname: Yeh
authors.forename: L S
authors.initials: LS
authors.lastname: Ou
authors.forename: M H
authors.initials: MH
authors.lastname: Yang
authors.forename: J L
authors.initials: JL
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D001799:Blood Sedimentation; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D020551:Pulse Therapy, Drug; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D018799:Intercellular Adhesion Molecule-1; D003520:Cyclophosphamide; D008775:Methylprednisolone