The Effect of Leflunomide on Cold and Vibratory Sensation in Patients with Rheumatoid Arthritis
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective To evaluate the prevalence and risk factors of peripheral neuropathy in patients with rheumatoid arthritis (RA) treated with lefl unomide (LEF) by quantitative sensory testing (QST). Method A total of 94 patients were enrolledin this study, out of which 47 patients received LEF. The other 47patients received alternative disease-modifying antirheumatic drugs and served as the control group. The demographic characteristics, laboratory fi ndings, concomitant diseases, and medication history were evaluated at the time of QST. Th e cooling (CDT) and vibratory detection threshold (VDT) as the representative components of QST were measured. Results Age, gender, RA duration, ESR, and CRP did not show any signifi cant diff erences between the two groups. VDT did not demonstrate any signifi cant diff erence in both groups. However, CDT in LEF group was signifi cantly higher than that of the control group (8.6±2.7 in LEF vs. 5.6±3.8 in control). The proportion of RA patients in the LEF group showing abnormally high CDT was over 2 times greater than that of the control group, but these fi ndings were not statistically signifi cant. Age, RA duration (or LEF medication in LEF group), ESR, and CRP did not show signifi cant correlation with CDT in both groups. VDT signifi cantly correlated with age in both groups. Conclusion LEF treatment in patients with RA may lead to abnormal CDT in QST. CDT value was not aff ected by age, RA duration, disease activity, or LEF duration. It remains to be determined whether QST may be a valuable non-invasive instrument to evaluate the early sensory changes in patients with RA taking LEF.
Abstract
Objective To evaluate the prevalence and risk factors of peripheral neuropathy in patients with rheumatoid arthritis (RA) treated with lefl unomide (LEF) by quantitative sensory testing (QST). Method A total of 94 patients were enrolledin this study, out of which 47 patients received LEF. The other 47patients received alternative disease-modifying antirheumatic drugs and served as the control group. The demographic characteristics, laboratory fi ndings, concomitant diseases, and medication history were evaluated at the time of QST. Th e cooling (CDT) and vibratory detection threshold (VDT) as the representative components of QST were measured. Results Age, gender, RA duration, ESR, and CRP did not show any signifi cant diff erences between the two groups. VDT did not demonstrate any signifi cant diff erence in both groups. However, CDT in LEF group was signifi cantly higher than that of the control group (8.6±2.7 in LEF vs. 5.6±3.8 in control). The proportion of RA patients in the LEF group showing abnormally high CDT was over 2 times greater than that of the control group, but these fi ndings were not statistically signifi cant. Age, RA duration (or LEF medication in LEF group), ESR, and CRP did not show signifi cant correlation with CDT in both groups. VDT signifi cantly correlated with age in both groups. Conclusion LEF treatment in patients with RA may lead to abnormal CDT in QST. CDT value was not aff ected by age, RA duration, disease activity, or LEF duration. It remains to be determined whether QST may be a valuable non-invasive instrument to evaluate the early sensory changes in patients with RA taking LEF.
참고문헌 (22)
- Breedveld FC, "Lefl unomide: mode of action in the treatment of rheumatoid arthritis", Ann Rheum Dis, 59, pp.841~849 (2000)
- Elkayam O, "Active leflunomide metabolite inhibits interleukin 1beta, tumor necrosis factor alpha, nitric oxide and metalloproteinase-3 production in activated human synovial tissue cultures", Ann Rheum Dis, 62, pp.440~443 (2003)
- Palmer G, "The active metabolite of lefl unomide, A77 1726, increases the production of IL-1 receptor antagonist in human synovial fibroblasts and articular chondrocytes", Arthritis Res Ther, 6, pp.181~189 (2004)
- Saag KG, "American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis", Arthritis Rheum, 59, pp.762~784 (2008)
- Kremer JM, "Benefi t", risk of lefl unomide in rheumatoid arthritis, 2004, pp.22(5), 95~100
- van Riel PL, "Lefl unomide: a manageable safety profi le", J Rheumatol, 71, pp.21~24 (2004)
- van Roon EN, "Lefl unomide for the treatment of rheumatoid arthritis in clinical practice: incidence and severity of hepatotoxicity", Drug Saf, 27, pp.345~352 (2004)
- Rozman B, "Leflunomide and hypertension", Ann Rheum Dis, 61, pp.567~569 (2002)
- Ito S, "Interstitial lung disease associated with lefl unomide", Intern Med, 43, pp.1103~1104 (2004)
- Metzler C, "Peripheral neuropathy in patients with systemic rheumatic diseases treated with lefl unomide", Ann Rheum Dis, 64, pp.1798~1800 (2005)
- Martin K, "Neuropathy associated with lefl unomide: a case series", Ann Rheum Dis, 64, pp.649~650 (2005)
- Kho LK, "Lefl unomide-induced peripheral neuropathy", J Clin Neurosci, 14, pp.179~181 (2007)
- Richards BL, "Effect of lefl unomide on the peripheral nerves in rheumatoid arthritis", Intern Med J, 37, pp.101~107 (2007)
- "American Diabetes Association American Academy of Neurology", Consensus statement: Report and recommendations of the San Antonio Conference of Diabetic Neuropathy, 11, pp.592~597 (1988), Diabetes Care
- Dyck PJ, "Vibratory and cooling detection threshold compared with other tests in diagnosing and staging diabetic neuropathy", Diabetes Care, 10, pp.432~440 (1987)
- Arnett FC, "The American Rheumatism Association 1987 revised criteria for the classifi cation of rheumatoid arthritis", Arthritis Rheum, 31, pp.315~324 (1988)
- Bonnel RA, "Peripheral neuropathy in patients treated with lefl unomide", Clin Pharmacol Ther, 75, pp.580~585 (2004)
- Lee SM, "Diagnostic usefulness of quantitative sensory test in diabetic polyneuropathy: comparison with nerve conduction study", J Korean Neurol Assoc, 17, pp.106~111 (1997)
- Carulli MT, "Peripheral neuropathy: an unwanted eff ect of lefl unomide?", Rheumatology, 41, pp.952~953 (2002)
- 김현철, "Ankylosing spondylitis, Henoch-Schönlein purpura", 대한류마티스학회지, 15(3), pp.273~276 (2008), 대한류마티스학회
- Martin K, "Peripheral neuropathy associated with lefl unomide: is there a risk patient profi le?", Pharmacoepidemiol Drug Saf, 16, pp.74~78 (2007)
- Fox RI, "Mechanism of action for leflunomide in rheumatoid arthritis", Clin Immunol, 93, pp.198~208 (1999)