Anti–tumor necrosis factor α blockade in the treatment of juvenile spondylarthropathy
- 28 June 2005
- journal article
- clinical trial
- Published by Wiley in Arthritis & Rheumatism
- Vol. 52 (7), 2103-2108
- https://doi.org/10.1002/art.21121
Abstract
Objective Persistent inflammation refractory to standard antirheumatic therapy in children with juvenile spondylarthropathy (SpA) leads to morbidity and reduced quality of life. Tumor necrosis factor α (TNFα) plays an important role in the pathogenesis of synovitis and enthesitis. This study was undertaken to examine the impact of anti‐TNFα agents on juvenile SpA that is refractory to nonsteroidal antiinflammatory drugs (NSAIDs), disease‐modifying antirheumatic drugs, and corticosteroids. Methods Ten juvenile SpA patients with a mean ± SEM age of 15.0 ± 0.7 years and disease duration of 4.4 ± 0.8 years, all of whom were HLA–B27 positive, were followed up for 1 year after initiation of either infliximab (n = 8) or etanercept (n = 2). Outcomes examined were within‐subject differences in the tender entheseal count (TEC) and active joint count (AJC), markers of inflammation, functional assessments (Childhood Health Assessment Questionnaire [C‐HAQ] score), and requirements for antirheumatic drugs. Results At baseline, all patients exhibited active arthritis and enthesitis that were resistant to NSAIDs (n = 10), methotrexate (n = 6), sulfasalazine (n = 8), corticosteroids (oral n = 6, intravenous pulse n = 3, and intraarticular n = 6), and bisphosphonates (n = 2). In 2 patients, sulfasalazine (n = 2), corticosteroids (n = 1), and bisphosphonates (n = 1) were stopped after initiation of the anti‐TNFα agent. In all patients, the arthritis and enthesitis significantly improved as evidenced by remission of the TEC and AJC by 6 months that was sustained during the 1‐year followup, markers of inflammation and C‐HAQ scores normalized, and there was a reduction in requirements for antirheumatic drugs (reduced dosage or discontinuation of NSAIDs n = 10, methotrexate n = 5, sulfasalazine n = 6, corticosteroids n = 4, and bisphosphonates n = 1). Conclusion Anti‐TNFα therapy is a potential novel treatment for refractory juvenile SpA. Further prospective studies are required to examine the effectiveness and long‐term outcomes of anti‐TNFα therapy in this cohort.Keywords
This publication has 25 references indexed in Scilit:
- The German etanercept registry for treatment of juvenile idiopathic arthritisAnnals Of The Rheumatic Diseases, 2004
- Long‐term efficacy and safety of etanercept in children with polyarticular‐course juvenile rheumatoid arthritis: Interim results from an ongoing multicenter, open‐label, extended‐treatment trialArthritis & Rheumatism, 2003
- A 26 week randomised, double blind, placebo controlled exploratory study of sulfasalazine in juvenile onset spondyloarthropathiesAnnals Of The Rheumatic Diseases, 2002
- Refractory inflammatory heel pain in spondylarthropathy: A significant response to infliximab documented by ultrasoundArthritis & Rheumatism, 2002
- Therapeutic use of etanercept in polyarticular course juvenile idiopathic arthritis over a two year periodAnnals Of The Rheumatic Diseases, 2002
- Preliminary definition of improvement in juvenile arthritisArthritis & Rheumatism, 1997
- Measurement of health status in children with juvenile rheumatoid arthritisArthritis & Rheumatism, 1994
- SERUM CYTOKINES (IL-6, TNF-α, IL-1β AND IFN-γ) IN ANKYLOSING SPONDYLITIS: A CLOSE CORRELATION BETWEEN SERUM IL-6 AND DISEASE ACTIVITY AND SEVERITYRheumatology, 1994
- The European Spondylarthropathy Study Group Preliminary Criteria for the Classification of SpondylarthropathyArthritis & Rheumatism, 1991
- BRIEF REPORT THE NATURAL HISTORY OF JUVENILE-ONSET ANKYLOSING SPONDYLITIS: A 24-YEAR RETROSPECTIVE CASE-CONTROL STUDYRheumatology, 1988