Abstract
Objective. To study effect of etanercept, an antagonist of serum A amyloid production in the AA amyloidosis treatment in juvenile idiopathic arthritis (JIA). Material and methods. Etanercept was administered to all pts with AA amyloidosis admitted to Garmisch-Paterkirchen pediatric rheumatological clinic beginning with 2000. C-reactive protein (CRP), degree of proteinuria and serum creatinin were used as preliminary outcome measures. Results. 11 pts with seronegative JIA (6 boys and 5 girls) were included in the study. Mean follow up duration was l,9±l.01 years. 8 children had systemic, 2 - olygoarticular and one - polyarticular disease onset. Before the study all pts had CRP level elevation (1,03-8,29 mg/dl, mean 4,53 mg/dl). 8 from 11 had marked proteinuria (364-7400 mg/24 hours, mean 1186 mg/24 hours). 2 from 11 had serum creatinin elevation. During etanercept treatment CRP level normalized in 2 and significantly decreased in 4 pts. Proteinuria decreased in 4 from 8 pts. Significant change of creatinin level was not achieved. One girl who did not have improvement during etanercept treatment showed CRP normalization and decrease of proteinuria when the drug was changed to infliximab. Conclusion. Treatment with etanercept provided improvement in almost 2/3 from 11 pts with JIA and AA amyloidosis. Etanercept may be the drug of choice in pts with normal creatinine level in the absence of proteinuria. When it fails another tumor necrosis factor antagonist such as infliximab should be used. It is necessary to extend volume and duration of the study to get more reliable data on etanercept efficacy in JIA pts with AA amyloidosis.
Highlights
ПЕДИАТРИЧЕСКАЯ РЕВМАТОЛОГИЯЭТАНЭРЦЕПТ В ЛЕЧЕНИИ АА-АМИЛОИДОЗА ПРИ ЮВЕНИЛЬНОМ ИДИОПАТИЧЕСКОМ АРТРИТЕ (предварительные результаты)
E tanercept was adm inistered to all pts with AA am yloidosis adm itted to G arm isch-Paterkirchen pediatric rheumatological clinic beginning with 2000
C-reactive protein (CRP), degree of proteinuria and serum creatinin were used as preliminary outcom e measures
Summary
ЭТАНЭРЦЕПТ В ЛЕЧЕНИИ АА-АМИЛОИДОЗА ПРИ ЮВЕНИЛЬНОМ ИДИОПАТИЧЕСКОМ АРТРИТЕ (предварительные результаты). И зучить действие этанэрцепта - антагониста образования сы вороточного амилоида А в лечении амилоидоза АА при ювенильном идиопатическом артрите (Ю ИА). На ф о не лечения этанэрцептом уровень СРБ нормализовался у 2-х и значимо снизился еще у 4-х па циентов. В случае нормального уровня креатинина и отсутствия протеину рии в начале лечения этанэрцепт может быть наиболее предпочтительным препаратом. Необходимо расширение объемов и сро ков исследования для получения более достоверных данных об эффективности этанэрцепта при АА-амилоидозе у больных ЮИА. Он является-антагонистом обра зования сывороточного амилоида A (SAA) и может быть предложен в качестве нового метода лечения АА-амилоидоза [4] (рис.) Мы поп ы тал и сь своей работой ответить на два вопроса: 1. В озм ож но ли предотвратить наруш ение ф ункц ии о р гана, вызванное отложением амилоидных белков или даже восстановить ее? Наш первый опыт дает только предварительные ответы на эти вопросы
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