Onset Juvenile Idiopathic Arthritis Research Articles

THU0302 Safety and efficacy of tocilizumab therapy in children with systemic onset of juvenile idiopathic arthritis

BackgroundThe treatment of systemic onset of juvenile idiopathic arthritis (JIA is one of the serious problem of paediatric rheumatology, therefore development and implementation of new high-tech methods of treatment is...

AB1192 Epidemiology of juvenile idiopathic artritis-associated uveitis in spain: Results from a national registry

BackgroundUveitis is one of the major extra-articular manifestations of Juvenile Idiopathic Arthritis (JIA), appearing in 10-30% of these patients. Most cases of uveitis in JIA patients are asymptomatic, bilateral and...

SAT0468 Is Early Treatment with Biologics Associated with a Better Long-Term Outcome in Patients with Polyarticular Juvenile Idiopathic Arthritis (JIA)?

BackgroundApproximately one in three children with polyarthritis is currently being treated with a biologic agent in Germany. Biologics are not only increasingly used more frequently in JIA, but also earlier...

SP0145 Challenges faced by parents with a child having a rheumatic disease

There are multiple challenges parents of a chronically ill child have to face. The background family situation including psychological and socioeconomic factors plays a major role in the development of...

OP0063 Efficacy and Safety of Adalimumab in Children with Juvenile Idiopathic Arthritis

BackgroundSince Adalimumab has been approved for the polyarticular course of juvenile idiopathic arthritis (JIA) for ages 4 to 18 in 2008, children treated with Adalimumab have been monitored prospectively in...

AB1160 Golimumab in 25 young adults affected by juvenile idiopathic arthritis (JIA) non responders to other biological agents: Preliminary data

BackgroundBiological agents licensed in JIA have demonstrated a favourable benefit-to-risk profile. Nevertheless, intolerance, loss and lack of efficacy or adverse events have led to try other therapeutic options.ObjectivesTo evaluate efficacy...

AB1159 Certolizumab in juvenile idiopathic arthritis (JIA): Experience of 12 patients treated

BackgroundBiological agents have demonstrated a favourable benefit-to-risk profile. Nevertheless, intolerance, lost of efficacy or adverse events has led to try other therapeutic options as the use of new TNF-inibithors. Since...

SAT0432 Development of Positive Antinuclear Antibodies and Rheumatoid Factor in Systemic Juvenile Idiopathic Arthritis Points toward an Autoimmune Phenotype Later in the Disease Course

BackgroundSystemic onset Juvenile Idiopathic Arthritis (JIA) is now commonly considered part of the group of autoinflammatory diseases. However, systemic inflammation tends to decrease over time, leading to a phenotype of...

FRI0324 Experience with adalimumab in 123 patients with juvenile idiopathic arthritis (JIA)

BackgroundAdalimumab is a fully human anti-TNF monoclonal antibody approved for the treatment of resistant polyarticular juvenile idiopathic arthritis at a dosage of 24 mg/kg/m2. every other week in children below...

THU0329 OPG/RANK/RANKL in pathogenesis of osteoporosis of juvenile idiopathic arthritis (JIA) subtypes

BackgroundA decrease in bone mass has been described in a high percentage with increased risk of osteoporosis in JIA subtypes. The pathogenesis of bone loss in active JIA is complex,...

SAT0128 Efficacy and safety of adalimumab treatment for refractory juvenile idiopathic arthritis-associated uveitis

BackgroundThe treatment of juvenile idiopathic arthritis (JIA)–associated uveitis is one of the serious problem of paediatric rheumatology, therefore development and implementation of new methods of treatment is relevant. Humanised anti-TNFα...

Significance of serum anti-cyclic citrullinated peptide antibodies in diagnosis of juvenile idiopathic arthritis

Objective To investigate the clinical significance of serum anti-cyclic citrullinated peptide(anti-CCP) antibodies in diagnosis of juvenile idiopathic arthritis(JIA). Methods Serum anti-CCP antibodies of 68 children suspected of JIA with fever and arthritis of unknown causes were determined by ELISA,and comprehensive analysis was carried out with clinical data and related laboratory findings. Results Among the 68 children suspected of JIA,there were 10 cases of polyarticular JIA,13 cases of systemic onset JIA,8 cases of oligoarticular JIA and 13 cases of enthesitis related JIA.There were 11 cases of other rheumatoid diseases,8 cases of neoplastic diseases of blood and 5 cases of infectious diseases.The serum anti-CCP level in children suspected of polyarticular JIA was significantly higher than those in children suspected of systemic onset JIA,oligoarticular JIA and enthesitis related JIA(P0.05).With serum anti-CCP ≥15.8 RU/mL as the positive threshold value,the area under receiver operating characteristic curve was 0.80,and the sensitivity and specificity in diagnosis of polyarticular JIA were 80% and 67.6% respectively.The serum anti-CCP level was positively related to serum C-reaction protein level in children suspected of polyarticular JIA(r=0.764,P=0.017). Conclusion Serum anti-CCP can be used for the diagnosis of polyarticular JIA,and 15.8 RU/mL may be a suitable cut-off level.

Psychological Intervention for Adolescents with Juvenile Idiopathic Arthritis: For Whom and When?

To study which adolescents with juvenile idiopathic arthritis (JIA) benefit from psychological intervention, and what is the best moment for it. In 3 months, 28 adolescents with JIA and 14 healthy adolescents as a control group received psychological intervention with the Self-confrontation Method (SCM), which combines the personal narrative with its affective structure. The adolescents with JIA were split into groups with low health-related quality of life (HRQOL) and high HRQOL. The Child Health Questionnaire, Checklist Individual Strength, and Childhood Health Assessment Questionnaire were used to measure fatigue and physical and psychosocial functioning at baseline, and at 3 months and 9 months after baseline. Adolescents with JIA and low HRQOL at baseline reported less fatigue and better HRQOL after psychological intervention. These changes could not be explained by changes in disease activity. Low HRQOL at baseline was associated with a more recent onset of JIA, higher levels of pain, more severe physical disability, and higher levels of fatigue. Two-thirds of adolescents with JIA function well before and after psychological intervention. One-third of adolescents with JIA reporting low HRQOL at baseline benefit from guided self-reflections and should be the focus of psychological intervention. The most effective moment for this psychological intervention is when the adolescent reports difficulties in HRQOL.

Residents' journal review

Residents' journal review

P160 A humanized anti-IL-6 receptor antibody for the treatment of chronic inflammatory diseases

Introduction Interleukin 6 (IL-6) is one of pro-inflammatory cytokine and is contributed in the pathological function of chronic inflammatory disease and autoimmune disease. Therefore, IL-6 blockade, a humanized anti-IL-6 receptor antibody, tocilizumab was established, which inhibited IL-6 activity both in vitro and in vivo before utilizing clinical therapy. Methods Since 1999, we performed clinical studies against Castleman’s disease (CD), rheumatoid arthritis (RA) and systemic onset of juvenile idiopathic arthritis (sJIA). Results Almost 95% clinical efficacy was obtained by tocilizumab for the patients with CD. Against the patient with sJIA who could not controlled with any previous medicine and TNF-α blockades, tocilizumab therapy showed 90% efficacy assessed by JIA core set. In the case of RA, clinical studies of tocilizumab were performed with 8000. In results, tocilizumab therapy for RA is tolerated and a most effective therapy in sign and symptom and joint event among the biological reagents assessed by ACR or DAS 28 criteria, and Sharp score. Moreover, tocilizumab therapy showed remarkable clinical efficacy without combination of methotrexate. Not only clinical efficacy, but also most of laboratory findings were shown the improving and normalization of such as CRP, SAA, Fib, Hb, CH50, and MMP-3. Conclusion Since IL-6 blockage is effective for CD, RA, and sJIA, other IL-6 contributed chronic inflammatory disease may be targeted diseases of tocilizumab, such as chronic angitis, autoimmune disease, autoinflammatory diseases, inflammatory bowel disease, amyloidosis, Bechget’s disease and so on.

Elbow monoarthritis: an atypical onset of juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic condition in childhood and an important cause of short and long term disability. Oligoarthritis is defined as an arthritis that affects four o fewer joints during the first 6 months of disease. The large majority of patients within this category belongs to a quite well defined disease which is not observed in adults. It is characterized by an early onset (before 6 years of age), an asymmetric arthritis involving mainly large joints, a female predilection, a high frequency of positive antinuclear antibodies (ANA), a high risk for developing chronic iridocyclitis and consistent HLA associations. We describe 3 clinical cases who presented monoarthritis of the elbow as early sign of oligoarticular JIA. All patients showed inflammatory markers elevation and 2/3 were ANA positive. MRI showed the presence of synovial inflammation without bone involvement. Intraarticular triamcinolone hexacetonide, led to remission in one case, while in the other two there was a re-activation of the disease treated with NSAIDs and/or MTX. The reported cases represent 0.6% of 490 patients with JIA followed by our unit in the last 10 years. Cases of exclusive involvement of the elbow at onset of JIA in literature are rare. Therefore, we report 3 cases of monoarthritis of the elbow as initial sign of oligoarticular JIA, a very atypical onset of this disease.

THE ROLE OF THE SOLUBLE TNF-ALPHA RECEPTORS IN TREATMENT OF JUVENILE IDIOPATHIC ARTHRITIS

The results of the study of etanercept (soluble tumor necrosis factor alpha receptors) efficacy and safety in treatment of 97 patients with early and late onset of juvenile idiopathic arthritis are demonstrated in this article. The observation period was 12 months. In 48 weeks of anti-TNF treatment the achievement of clinical remission, decrease and normalization of laboratory markers of disease activity, complete restoration of joints function and improvement of life quality was established in 100% of children with early onset and 71% of children with late onset of arthritis. The drug was withdrawn in 13 (14%) patients: in 5 (6%) due to inefficiency, in 3 (4%) — due to development of side effects.

Anti-cyclic citrullinated peptide (anti-CCP) antibody in juvenile idiopathic arthritis (JIA): Correlations with disease activity and severity of joint damage (a multicenter trial)

ObjectivesTo determine the presence of anti-CCP antibodies in children with JIA and to correlate its levels with Juvenile Arthritis Disease Activity Score (JADAS) and Sharp/Van der Heijde Score. MethodsThe study population comprised 54 cases, with 29 patients (53.7%) who had polyarticular onset, 19 (35.2%) had pauciarticular onset and six (11.1%) had systemic onset JIA. All patients were subjected to complete clinical examination, assessment of disease activity by JADAS-27 (ESR), and radiological damage by Sharp/Van der Heijde Score. Laboratory investigations included a complete blood count, ESR first hour, ANA, IgM Rheumatoid factor (RF) and serum anti-CCP2, and were used for further correlations. ResultsRF was positive in 14 (25.9%) patients and anti-CCP antibodies were positive in 13 (24.1%) patients, 12 of whom had polyarticular onset. There were significant differences between groups relative to RF (F=8.577, P=0.001) and anti-CCP antibodies (F=4.845, P=0.012) being higher in JIA patients with polyarticular onset compared to other subsets of JIA patients. The mean total of the Sharp/Van der Heijde Score was significantly higher among polyarticular-JIA patients with positive anti-CCP antibodies compared to those negative for anti-CCP antibodies (P=0.05). Anti-CCP positively correlated with CRP (r=0.521, P<0.001) and Sharp/Van der Heijde Score (r=0.457, P<0.001). ConclusionAnti-CCP antibodies were prevalent among JIA patients with polyarticular patterns compared to other disease patterns. Anti- CCP positively and significantly correlated with Sharp's score and CRP levels. Given that anti-CCP may be influential in the choice of the best therapeutic strategy in JIA with polyarticular pattern of onset.

Response to Etanercept in Juvenile Idiopathic Arthritis

in Juvenile Idiopathic Arthritis To the Editor: The study presented by Dr Otten and colleagues assessed factors associated with treatment response to etanercept in patients with juvenile idiopathic arthritis (JIA). They found that approximately one-third of the patients with JIA achieved an excellent response, which was associated with low baseline disability scores, low numbers of disease-modifying antirheumatic drugs used before initiating etanercept, and younger age at onset of JIA. Onethird achieved a poor response, which was associated with systemic JIA and female sex. However, we think that their conclusions are problematic because differences between systemic JIA and other types exist in terms of intrinsic etiology and pathogenesis. Information about the immune pathogenesis of JIA discovered in the past 5 years has confirmed that systemic JIA is a different disease from other types of JIA and should be treated as an acquired autoinflammatory disease. Juvenile idiopathic arthritis is not only a heterogeneous group of diseases characterized by arthritis of unknown origin with onset before the age of 16 years but also a diagnosis of exclusion, which is made only when other causes such as congenital joint deformity, neurovascular disorder, trauma, and infection have been ruled out. The discrepancies in treatment response in Otten et al’s study also suggest that the diagnosis of JIA encompasses different categories with different etiologies and pathogenesis, so the major factor associated with treatment response to etanercept in JIA may be the type rather than sex or age. Thus, the comparison of treatment response between systemic JIA and other categories may not be helpful; the comparison with greater significance for clinical practice would be a comparison within types—systemic or nonsystemic.

EVALUATION OF EFFICACY AND SAFETY OF COMPLEX TREATMENT WITH INFLIXIMAB AND METHOTREXATE COMPARING WITH METHOTREXATE MONOTHERAPY OF CHILDREN WITH JUVENILE POLYARTICULAR IDIOPATHIC ARTHRITIS

In this study the results of the investigation of complex treatment with Infliximab and Methotrexate efficacy and safety of 28 patients comparing with Methotrexate treatment of 41 patients with polyarticular juvenile idiopathic arthritis at the age of 8–17 years are analyzed. The follow-up period was 1 year. Infliximab was administered according to the following scheme: 0, 2, 6 weeks and then every 8 weeks. The dosage of Infliximab in children with early onset of juvenile idiopathic arthritis was 3,0 mg/kg per infusion. Clinical remission, decrease and normalization of laboratory markers, complete restoration of joints function and improvement of life quality in 57,7% were established after 46 weeks of treatment with Infliximab and Methotrexate comparing with 16% in children treated with Methotrexate monotherapy.