Background Tumor necrosis factor alpha blockade (anti-TNF) therapy is efficacy and safe in juvenile idhiopatic arthritis (JIA). Changes in biologic therapy (BT) doses are frequent in daily clinical practice, and tapering of anti-TNF therapy is common when remission is achieved1. There are still few data about anti-TNF tapering2. On the other hand, subclinical synovitis detected by ultrasound (US) could predict flares in adult rheumatoid arthritis patients, but seems not to be the same in JIA3.
Objectives Our aim is to evaluate the predictive value of subclinical synovitis detected by power Doppler US in relation to flares in patients diagnosed with JIA in remission under anti-TNF therapy in whom therapy is tapered
Methods Observacional, prospective and multicenter study. We included JIA patients in remission at least 6 months with anti-TNF therapy (etanercept and adalimumab) in whom anti-TNF was tapered by clinical reasons. Etanercept was tapered by increasing 3 days the injection and adalimumab by increasing a week the injection. Patients were assessed every 3 months clinically and also with Doppler US at baseline and 6 months. Doppler US assessment included elbow, wrist, 1st and 2nd metacapophalangeal and interphalangeal, knee, ankle and 1st and 2nd metatarsophalangeal, all bilaterally. Synovitis definitions from adults were used because no synovitis definitions are available for JIA yet. We asked for date of birth, JIA subcategory, previous and current treatments, date of BT onset and date of 1st tapering. Flare was defined as clinical symptoms or signs of arthritis activity that required increase of systemic therapy
Results We included 35 patients at the moment, mean follow-up 6.5 months (SD 3.5 months). From the 35 patients, 26 (74.3%) were under treatment with etanercept and 9 (25.7%) with adalimumab. Table 1 shows demographic data. Median time under BT before tapering was 2.2 years (IR 1.2-4.5), and median time in remission before tapering by protocol was 20 months (IR 12-26 months). 12 patients (34.3%) were under tapered dose before study inclusion, 9 with etanercept and 3 with adalimumab. Until now 8 patients (22.3%) have had a flare, with a mean time to flare of 5.1 months. US do not predict flare in our cohort (global synovitis score at baseline was 5 and 4.5 at 6 months in B mode, and 0 at baseline and at 6 months in Doppler (p>0.05).
Conclusions Our preliminary results support that anti-TNF tapering in patients with JIA in sustained remission is safe. US do not predict flares in our patients until now. Our results should be confirmed at the end of the study
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Verazza S. Clin Exp Rheumatol. 2013;31:S98-101.
Magni-Manzoni S. Ann Rheum Dis. 2013;72:223-8.
Disclosure of Interest None declared