台灣幼年特發性關節炎之全國流行病學研究及其用藥之相關風險; Epidemiologic of Juvenile Idiopathic Arthritis and Risk Associated with Its Treatment: A Population-Based Cohort Study in Taiwan

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Title:	台灣幼年特發性關節炎之全國流行病學研究及其用藥之相關風險;Epidemiologic of Juvenile Idiopathic Arthritis and Risk Associated with Its Treatment: A Population-Based Cohort Study in Taiwan
Authors:	莊來鎮;Zhuang,Lai-Zhen
Contributors:	資訊工程學系
Keywords:	幼年特發性關節;細菌感染;腫瘤壞死因子抑制劑;惡性腫瘤;肺結核;葡萄膜炎;Juvenile Idiopathic Arthritis;malignancy;tuberculosis;uveitis;infection;TNF-α
Date:	2013-07-22
Issue Date:	2013-08-22 12:10:35 (UTC+8)
Publisher:	國立中央大學
Abstract:	幼年特發性關節炎是一種異質炎症性關節炎，是兒童最常見的風濕性疾病，導致兒童長期殘疾或日常功能下降。其治療藥物包含非類固醇消炎藥、口服性類固醇、抗風濕藥物如MTX以及腫瘤壞死因子抑制劑如TNF-α抑制劑，腫瘤壞死因子抑制劑已被證明對於治療幼年特發性關節炎是非常有效的，但是有一些安全性的議題被討論，例如使用腫瘤壞死因子抑制劑後可能會增加惡性腫瘤、肺結核、及細菌感染的危險。此研究的目的是要了解台灣幼年特發性關節炎的發生率及盛行率，另外也要討論幼年特發性關節炎患者和一般兒童相比，本身對於惡性腫瘤、肺結核、葡萄膜炎、及細菌感染之風險，以及用藥後是否會進一步地增加風險。我們計算出幼年特發性關節炎之發生率為每十萬人口15.7個新發病例，盛行率為每十萬人口29.8個病例。我們也發現幼年特發性關節炎比一般兒童有較高的惡性腫瘤、葡萄膜炎、以及感染風險，再使用MTX後會顯著增加3.1倍葡萄膜炎的風險和1.7倍感染的風險，使用TNF-α的病人會顯著增加4.1倍葡萄膜炎的風險。 Juvenile idiopathic arthritis (JIA) is a heterogeneous group of conditions defined as inflammatory arthritis occurring in children under 16 years old, it is the most common rheumatic disease in children to be the cause of short and long term disability in children with decreased daily function and quality of life. The treatments of JIA include a combination of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease modifying anti-rheumatic drugs (DMARDs) of which methotrexate (MTX) is most commonly used, and biological therapies such as tumor necrosis factor alpha (TNF-α) inhibitors. TNF-α inhibitors have been shown to be highly effective in the treatment of JIA. However, there was some safety issues about a possible increased risk of bad outcome associated with their use, such as malignancy (especially lymphoma), tuberculosis, uveitis, and infection. We found a incidence rate of JIA with the value 15.7 per 100,000, and the prevalence rate of JIA with the value 29.8 per 100,000 in Taiwan from 2002 to 2008. We found a higher risk of malignancy, uveitis, and infection among the JIA patients compare to non-JIA cohort, a significantly increased 3.1-fold rate of uveitis and 1.7-fold rate of infection among JIA patients with MTX use, an increased 4.1-fold rate of uveitis among JIA patients treat with TNF-α inhibitors.
Appears in Collections:	[Graduate Institute of Computer Science and Information Engineering] Electronic Thesis & Dissertation

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