Background Juvenile arthritis (JA) is one of the most common and disabling rheumatic disease in children. Severe manifestation of juvenile arthritis is a systemic osteoporosis. There is currently no developed approaches to the treatment of children with systemic osteoporosis. In adult patients with rheumatoid arthritis the first-line treatment drug for osteoporosis is bisphosphonates
Objectives To evaluate the efficacy and safety of ibandronic acid for intravenous administration for treatment of severe systemic osteoporosis in patients with juvenile arthritis.
Methods The study included 25 patients with juvenile arthritis at the age of 7 to 17 years (10 girls, 15 boys), including 20 patients with systemic arthritis, 3 - with polyarthritis, 2 - with ankylosing spondylitis. The mean age was 12.5 (10.5, 14.0) years. Was allocated to 2 groups: 17 children treated with glucocorticoids (GC) and 8 - not receiving GC.Children of the first group had 12 vertebral fractures and patients of the 2-d group - 1. Ibandronic acid was administered intravenously at a dose of 3 mg every 12 weeks. Evaluation of treatment efficacy was conducted by a combined index of bone mineral density of tissue Z-score, assessing the patient/parent to the severity of pain on a visual analog scale, serum markers of bone resorption C-terminal telopeptide.
Results The treatment of ibandronic acid in children of both groups increased the bone mineral density. In patients treated with GC, a statistically significant increase was registered in 76 weeks of therapy (p<0.01), while the second group of children - through 46 and 76 weeks (p<0.05). Within 6 months of treatment in both groups of ibandronic acid was a statistically significant reduction in pain index (p<0.05), after a year of treatment with this trend persisted (p<0.001). In both groups, reducing the concentration of C-terminal telopeptide in serum were detected through 52 weeks of reatment (p<0.05). After 76 weeks of treatment new vertebral fractures and fractures of the peripheral skeleton are not fixed. Tolerability of therapy ibandronic acid in patients was satisfactory.
Conclusions In the course of the study has identified high efficacy and an acceptable tolerability ibandronic acid for treatment of severe systemic osteoporosis in patients with juvenile arthritis
Disclosure of Interest None Declared
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