Treatment of Juvenile Psoriatic Arthritis with Anti-interlukin-17 – A Case Report

Abstract

Background Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory joint disease in children and adolescents. Historically, moderate to severe psoriatic arthritis were treated with disease-modifying anti-rheumatic drugs, such as methotrexate. Since the 2000s, biologics such as TNF-inhibitors had been used for severe or refractory disease. More recently, Secukinumab, an anti-IL-17 monoclonal antibody, was approved in the US for treatment of psoriatic JIA since 2021. Methods We describe a case of psoriatic JIA, who was to our knowledge the first paediatric patient to be treated with Secukinumab in Hong Kong. Results A 12-years-old Chinese girl presented with 6-months history of plaque psoriasis associated with left hip pain. (Figure 1) Her JADAS10 score was 16.5 and her PASI score was 10.4. Naproxen, topical steroids and oral methotrexate were used but did not significantly improve her symptoms. An MRI scan continued to show evidence of active sacroiliitis. The patient was treated with Secukinumab at a loading dose of 150mg weekly SC for five weeks, followed by a maintenance dose of 150mg monthly. After one month, her inflammatory markers normalised and her JADAS10 score was 0, indicating inactive arthritis. After 3 months, her PASI score was 0.6. Follow-up of her skin condition showed complete solution of psoriasis at 6 months. (Figure 2) Conclusion Secukinumab induced rapid disease remission in a Chinese paediatric patient with PsJIA. It helped prevent progressive joint damage and greatly improved her skin’s cosmetic appearance. Our case demonstrated the remarkable efficacy of Secukinumab in the treatment of PsJIA.