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Rheumatology 1999; 38: 743-746
© 1999 British Society for Rheumatology

Paediatric Rheumatology: Autologous Stem Cell Transplantation in Rheumatic Diseases of Childhood

Long-term toxicity of immune suppression in juvenile rheumatic diseases

Series Editor: P. Woo

R. M. Laxer

Departments of Paediatrics and Medicine, University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada

Correspondence to: R. M. Laxer, Department of Paediatrics and Medicine, University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.

Therapy of patients with chronic disease may have serious consequences years after the treatment has been administered. This article will address medications used in children and adolescents with rheumatic disease that have short-term toxicity with long-term implications, as well as medications that may not have short-term toxicity but have potential long-term risks, and will focus on the medications that are currently in common use for patients with rheumatic disease. It is extremely difficult to ascertain the long-term risks for many reasons (Table 1Go), particularly small numbers of patients treated and closely followed for a prolonged period of time, resulting in an inability to determine true risks. Only careful, long-term follow-up studies with large cohorts of well-categorized patients will provide some insight into these risks.


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  		TABLE 1.  Reasons for difficulties in ascertaining long-term risks of immunosuppression from current studies
 
When one considers this topic, it is important to remember . . . [Full Text of this Article]

Corticosteroid therapy

Methotrexate

Classic `anti-rheumatic' agents

Sulphasalazine
Gold
Penicillamine
Hydroxychloroquine
Cyclosporin A
Azathioprine

Alkylating agents

Cyclophosphamide
Chlorambucil

Immunomodulation

Summary

References


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