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  1. I. Nikishina1,
  2. S. Arsenyeva1,
  3. M. Kaleda1,
  4. A. Shapovalenko1,
  5. O. Kostareva1,
  6. A. Latypova1,
  7. T. Pachkoria1
  1. 1V. A. Nasonova Research Institute of Rheumatology, Paediatric, Moscow, Russian Federation


Background: Juvenile psoriatic arthritis (JPsA) is one of the clinical variants of juvenile idiopathic arthritis (JIA), which is often characterized by an unfavorable course, refractory to therapy, requiring the prescription of Biological agents (BA).

Objectives: analysis of BA use in patients with JPsA and therapy survival, switching to another line of BA.

Methods: the retrospective cohort study included 1095 JIA patients who received BA and were observed in our clinic from 2004 to 2019. All cases of new onset psoriasis were collected; clinical features of disease onset and course, exposure to Methotrexate (MTX) and BA, presence of ANA, HLA B27 were studied.

Results: among 1095 JIA patients who received BA over the past 15 years, a separate cohort of patients with JPsA for analysis was allocated. We identified 50 pts (57% female) aged 2-18 years (Me 13.3) at the time of initiation of therapy. All patients met the JPsA classification criteria, the average age of arthritis onset was 7.4±5.3 years (ME 6.75). However, cutaneous psoriasis occurred only in 68 %(34 pts), with manifestation at the age of 10±5 years. In 25 of 34 pts (73.5%) the development of psoriasis was preceded by joint manifestations in an average of 5±3.9 (ME 3) years. 6 pts from 1095 (0.65%) developed psoriasis under BA therapy: infliximab - 2 cases (0.62/100PY), adalimumab - 3 (0.15/100PY), abatacept -1 (0.31/100PY). 2/6 pts was ANA+, 3/6 – HLA B27+. Average age of disease onset was 9.8±7.8 years; BA exposure before psoriasis was 2.7±1.1 years and in 3.6±1.3 (ME 4) after the onset of arthritis. Therapy was continued in 4/6 pts; switched from infliximab to adalimumab in 2. Serious comorbid pathology was associated with JPsA in 7 pts (type 1 diabetes mellitus – 2 pts; Down syndrome; endogenous mental illness (schizophrenia); oligophrenia; ovaries polycystic; acute lymphoblastic leukemia in a state of incomplete remission). The clinical picture of the disease was represented by polyarthritis in 84%, oligoarthritis in 8%, the same number of patients 8% had an axial lesion. Sacroiliitis was detected in 20 patients (40%), dactylitis in 21 (42%), and uveitis in 10 (20%). HLA B27 was detected in 16/35 pts (45%), 32% pts were ANA-positive. The duration of the disease at the time of application of the first BA was 5±4 (Me 3.75) years. In 49 patients, BA was used in combination with methotrexate. The total number of BA courses switching included was 80 (infliximab-19, adalimumab-22, etanercept-27, golimumab-4, abatacept-5, tocilizumab-2, rituximab-1). 49% of patients have experience of using >2 BA (16 pts-2 BA, 4 pts-3 BA, 1 pt - 5 BA). Primary/secondary inefficiency (18/35; 51%), adverse events (8/35; 23%), organizational difficulties in market access mostly after the age of 18 (7/35; 20%), and remission (2/35; 6%) were the reasons for the withdrawn of BA. Among the serious adverse events, multiple sclerosis was registered after 6 years of abatacept using (the relationship with the drug used has not been proven), pregnancy in the 3rd year of adalimumab use (interruption at 16 weeks); serious local reaction after etanercept using– 1; infusion reactions (1-rituximab, 2-infliximab); uveitis de novo (2- etanercept).

Conclusion: JPsA is one of the most severe variants of JIA, characterized by a high proportion of serious comorbid conditions, the development of refractoriness and adverse events of BA therapy (including uveitis, multiple sclerosis), requiring switching to line 2 and 3 with a limited choice of BA with pediatric indications. Special study requires the manifestation of psoriasis de novo mainly developed during TNF-monoclonal antibodies therapy.

Disclosure of Interests: None declared

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