Background Recently due to application of genetically engineered biologic drugs (GEBD) prognosis for juvenile idiopathic arthritis (JIA) has significantly improved. 558 children with JIA are under monitoring in Chelyabinsk region. If basic therapy with Methotrexane is inefficient Etanercept is the drug of choice for JIA treatment. Etanercept is registered within the Russian Federation for use in children older than 2 years. In Chelyabinsk regional children hospital Etanercept has been used during 5 years.
Methods 23 children aged from 2 to 17 (mean age 9.2 years) diagnosed with JIA were under monitoring (10 boys, 13 girls). Disease duration was from 6 months to 14 years (mean duration 4.5 years). JIA was diagnosed based on ILAR diagnostic criteria. Oligo arthritis was diagnosed in 8 children, sero-negative polyarthritis was diagnosed in 8 children. Five patients had systemic JIA (without active systemic presentations), two children had enthesitic JIA. X-ray stage 1–2 was observed in 22 children and stage 3 in one. Enhancement antigens HLA B 27 were found in 7 children. In all children Methotrexate was ineffective in dose of 15 mg/m2 during 6–12 months. Etanercept was introduced in dose of 0.4 mg s/c biweekly, or 0.8 mg QW. Therapy duration was from 3 months to 5 years (mean duration 17 months). Assessment of disease activity and therapy efficiency was conducted in accordance with ACR pedi criteria. Nonparametric statistical methods were used to compare results.
Results Prior to etanercept use high disease activity was observed in all children. Mean number of joints with active arthritis was 6 [3, 8] (Me [25; 75%]). Mean number of joints with functional impairments – 4 [2, 8]. Mean ESR (according to Panchenkov) – 31 [18.40] mm/h, CRP 19.7 [8.37] g/L. Assessment of functional activity according to CHAQ questionnaire- 1 [0.75; 2]. Activity assessment according to VAS by doctor – 70 [70,80]. Assessment of parents/patients according to VAS 80 [65,90]. No active systemic presentations and eye lesions were found in children under monitoring.
On the background of eternacept therapy a decrease in disease activity was observed in 21 patients. Mean number of joints with active arthritis was 0 [0, 1] (Me [25; 75%]) (P=0.0004). Mean number of joints with functional impairments – 1 [0.2] (P=0.0006). Mean ESR was 4 [3.7] mm/h (P=0.00008), CRP 3 [1; 4.1] g/L (P=0.0001). Assessment of functional activity according to CHAQ questionnaire was 0.25 [0; 0.5] (P=0.0004). Activity assessment according to VAS by doctor – 10 [10, 30] (P=0.0004). Assessment of parents according to VAS 20 [10, 30] (P=0.0004).
Clinical disease remission (according to ACR pedi criteria– ≥90%) was observed in 11 patients after 6–12 months of treatment. Remission duration up to now is from 3 months to 4 years. Efficiency according to ACR pedi criteria is 70% in 8 children, 50% in 1, 30% in 2.
The drug was well-tolerated. Drug was cancelled only in 2 patients due to change in disease presentations: one patient developed bilateral uveitis, the other one experienced recurrence with expressed systemic presentations.
Conclusions Etanercept therapy was highly effective and safe in patients with JIA. Clinical remission was achieved in 47.8% children. Decrease in disease activity was observed in 91.3% of children. No serious undesirable effects were reported.
Disclosure of Interest None declared