Tumour necrosis factor (TNF)-blocking agents in juvenile psoriatic arthritis: are they effective?
- Marieke H Otten1,
- Femke H M Prince1,
- Rebecca ten Cate2,
- Marion A J van Rossum3,
- Marinka Twilt1,2,
- Esther P A H Hoppenreijs4,
- Yvonne Koopman-Keemink5,
- Arnold P Oranje6,
- Flora B de Waard-van der Spek7,
- Simone L Gorter8,
- Wineke Armbrust9,
- Koert M Dolman10,
- Nico M Wulffraat11,
- Lisette W A van Suijlekom-Smit1
- 1Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- 2Department of Paediatrics/Paediatric Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- 3Department of Paediatrics/Paediatric Rheumatology, Emma Children's Hospital/Academic Medical Centre and Jan van Breemen Institute, Amsterdam, The Netherlands
- 4Department of Paediatrics/Paediatric Rheumatology, St Maartenskliniek Nijmegen and Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- 5Department of Paediatrics, Hagaziekenhuis Juliana Children's Hospital, The Hague, The Netherlands
- 6Paediatric Dermatology Unit, Department of Paediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- 7Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
- 8Department of Internal Medicine, Subdivision Rheumatology, University Hospital Maastricht, Maastricht, The Netherlands
- 9Department of Paediatrics/Paediatric Rheumatology, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, The Netherlands
- 10Department of Paediatrics/Paediatric Rheumatology, St Lucas Andreas Hospital and Jan van Breemen Institute, Amsterdam, The Netherlands
- 11Department of Paediatrics/Paediatric Rheumatology, Utrecht Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Correspondence to Dr Marieke H Otten, Department of Paediatrics, Erasmus MC Sophia Children's Hospital, Office Sp 1546, PO Box 2060, 3000 CB Rotterdam, The Netherlands;
- Accepted 11 August 2010
- Published Online First 10 November 2010
Objectives To evaluate the effectiveness of tumour necrosis factor (TNF) blockers in juvenile psoriatic arthritis (JPsA).
Methods The study was a prospective ongoing multicentre, observational study of all Dutch juvenile idiopathic arthritis (JIA) patients using biologicals. The response of arthritis was assessed by American College of Rheumatology (ACR) paediatric response and Wallace inactive disease criteria. The response of psoriatic skin lesions was scored by a 5-point scale.
Results Eighteen JPsA patients (72% female, median age onset 11.1 (range 3.3–14.6) years, 50% psoriatic skin lesions, 39% nail pitting, 22% dactylitis) were studied. The median follow-up time since starting anti-TNFα was 26 (range 3–62) months. Seventeen patients started on etanercept and one started on adalimumab. After 3 months of treatment 83% of the patients achieved ACR30 response, increasing to 100% after 15 months. Inactive disease reached in 67% after 39 months. There was no discontinuation because of inefficacy. Six patients discontinued treatment after a good clinical response. However, five patients flared and restarted treatment, all with a good response. During treatment four patients (two JPsA and two JIA patients with other subtypes) developed de novo psoriasis. In four of the nine patients the pre-existing psoriatic skin lesions improved.
Conclusion Anti-TNFα therapy in JPsA seems effective in treating arthritis. However, in most patients the arthritis flared up after treatment discontinuation, emphasising the need to investigate optimal therapy duration. The psoriatic skin lesions did not respond well and four patients developed de novo psoriasis.
Funding Board of Health Insurances from 2003 until 2006, and Wyeth International from 2007 until 2010.
Competing interests Wyeth International supported the development and maintenance of the web-based register unconditionally from 2007 until 2010.
Ethics approval This study was conducted with the approval of the Erasmus MC Rotterdam and all participating hospitals.
Provenance and peer review Not commissioned; externally peer reviewed.