克拉霉素治疗6例成人still病
Saviola G.et.al ( Rheumatol Int. 2009 Dec 23.)
成人still病是一种较少见的风湿病，以急性系统性症状为特征，目前还没有治疗指南。激素、甲氨蝶呤、环孢素A和生物制剂是常常有效的治疗药物。有学者用克拉霉素联合中小量的激素和甲氨蝶呤治疗6例成人still病疗效显著。其中4例患者在之前使用大剂量激素和改善病程抗风湿药（DMARDs）治疗无效；另外2例从治疗开始就使用中小量的激素和克拉霉素。克拉霉素的用法为500mg/次，2次/天。所有药物均根据临床和检验指标而减量或停用。结果治疗6个月时，有5位患者的疗效达到ACR70%，并在6～18个月之间停用了所有药物；另外一位患者则需小剂量激素，克拉霉素和甲氨蝶呤才能保持在ACR50%。
从以上病例报道可以看出，克拉霉素可以有效治疗成人still病，即使对于使用大剂量激素和DMARDs治疗无效的患者仍可有效。但该研究仅为病例报道，要得出确切结论，还需要大规模的随机对照试验。
Clarithromycin in adult-onset Still's disease: a study of 6 cases.
Rheumatol Int. 2009 Dec 23.
Saviola G, Benucci M, Abdi-Ali L, Baiardi P, Manfredi M, Bucci M, Cirino G.
Rheumatology and Rehabilitation Unit, Salvatore Maugeri Foundation IRCCS, Castel Goffredo, Mantua, 46042, Italy, gianantonio.saviola@fsm.it.
Adult-onset Still's disease (AOSD) is a rare rheumatological condition characterized by an acute systemic involvement. There are no treatment guidelines. Glucocorticoids (GC), methotrexate (MTX), cyclosporin A and biologic agents have been successfully used, often in association. We treated six cases of AOSD with clarithromycin (CM) in combination with low-mild dose of GC and MTX. Four of them were not responsive to high-dose GC added to DMARDs, while two of them were treated with low-mild dose of GC added to CM from the beginning. CM, 500 mg b.i.d., was added to a mild-low dose of GC and to MTX. The dose of the drugs was reduced (and stopped where possible) following clinical and laboratory parameters. ACR criteria were used to assess clinical improvement. At 6 months 5 patients reached ACR 70% and could stop any therapy in 6-18 months; 1 continued chronic therapy with low-dose GC added to CM and MTX to maintain ACR 50%. CM can be a useful drug for the treatment of AOSD, even in patients not responsive to high-dose GC and DMARDs. No definitive conclusion can be drawn based on the present study.