Background The use of biological DMARDs have important role in the treatment of juvenile idiopathic arthritis associated with uveitis.
Objectives The aim of this prospective observation was to assess the effectiveness and safety of abatacept (ABA) in the treatment of JIA with uveitis in children with severe JIA and resistance to standard antirheumatic therapy.
Methods Prior to ABA administration all children received immunosuppressive drugs: 17 children (100%) methotrexate (MTX) 10-15mg/m2 of body surface per week, 8 children (47%) received Ciclosporine as monotherapy in 3 children and in combination with methotrexate – 5 patients, 3 children (17, 6%) received oral corticosteroids (CS), 17 children (100%) received topical treatment of uveitis. Among 17 patients with JIA and eye involvement included in the study, 9 children had oligo-articular JIA, 7 children – polyarticular, 1 patient had systemic disease. Study group included 13 girls and 4 boys. Mean age was 10,7±3,5 years, age of disease onset was 5,3±3,2years; mean disease duration before ABA administration was 4±3,5. Disease onset with initial joint damage was observed in 10 children, with eye involvement in 7 children. Prior to ABA administration most children had high (III) disease activity. Number of active joints was 11, 7±2, 8, mean ESR was 30, 0±12,32mm/h, CRP 2, 28±1,05mg/dl (ref. <0,8mg/dl). VAS physician was 73, 4±15, 0, VAS patient/ parent was 68, 7±16, 2. Mean functional disability in patients before ABA administration was 2, 03±0, 48.All 17 patients had active uveitis at the moment of ABA administration. 9 (53%) patients had bilateral ocular involvement, 8 patients (47%) - unilateral.
Results After 6 month of ABA therapy, humoral activity decreased in 10 patients (58, 9%). ESR and CRP also substantially decreased. ACRpedi-30 was achieved in 100, 0% patients, ACRpedi-50-in – 8 patients (47%), ACRpedi -70- in –6 children (35, 3%). Uveitis remission was achieved in 22% eyes; 46% showed a significant reduction in inflammatory activity, 32% had no significant dynamics. After 12 month of ABA therapy, number of active joints decreased from 11, 7±2, 8 to 5, 63±1, 4. Mean ESR decreased from 30, 0±12, 32 mm/h to 10±4,6mm/h, CRP – from 2, 28±1, 05 mg/dl to 0±0, 31mg/dl, VAS physician decreased from 73, 4±15, 0 to 42, 4±13, 5, VAS patient/parent decreased from 68, 7±16, 2 to 30±16. ACRpedi-30 was achieved in 100, 0% patients, ACRpedi-50 in – 15 patients (88, 2%), ACRpedi-70in – 13 children (76, 5%). Regarding uveitis, 43% eyes had uveitis remission; 36% – sub active process. Flares were observed in 21% eyes.
Conclusions Abatacept was effective in some patients with chronic JIA and uveitis. No severe bacterial or viral infections; cases of malignancies or tuberculosis were observed during observation.
Ruperto N, Lovell DJ, Quartier P, Paz E, Rubio-Pérez N, Silva CA, et al. Abatacept in children with juvenile idiopathic arthritis: a randomised, double-blind, placebo-controlled withdrawal trial. Lancet 2008; 372:383-91.
Acknowledgements The staff of rheumatologic department of Pediatric Clinic of 1st Medical state University named after Sechenov
Disclosure of Interest None declared