Original articleEfficacy and safety of TNFα antagonist therapy in patients with juvenile spondyloarthropathies
Section snippets
Patients
We identified 20 patients who were given TNFα antagonists for at least 3 months to treat juvenile spondyloarthropathies meeting ILAR criteria as revised in Edmonton [5]. Before TNFα antagonist initiation, 18 of the 20 patients received one or more disease-modifying antirheumatic drugs (DMARDs), usually sulfasalazine, azathioprine, and/or methotrexate. All 20 patients had active disease (nocturnal pain, morning stiffness, and peripheral arthritis and/or enthesopathy) despite regular NSAID
Methods
The patients were identified by reviewing the medical records of patients, with juvenile spondyloarthropathy seen by either of two pediatric rheumatologists (CJD et PQDM) between December 1999 and January 2007. The first patient was started on TNFα antagonist therapy in September 2001 and the last patient in October 2006.
For each patient, the following data were abstracted from the medical chart: clinical presentation during the first year, treatments used before TNFα antagonist therapy,
Results
There were 16 males and 4 females with a mean age of 11.6 ± 2.3 years at diagnosis (range, 8–16.5 years). Mean time from symptom onset to diagnosis was 10.9 ± 19 months (range, 0–72 months). Mean disease duration at TNFα antagonist initiation was 10.0 ± 6.5 years. Of the 14 patients tested for the HLA B27 antigen, 13 were positive. A family history of spondyloarthropathy was noted in 8 patients. Extraarticular symptoms were present in 4 patients before TNFα antagonist initiation; they consisted of
Discussion
Juvenile spondyloarthropathies (enthesitis-related arthritis in the Edmonton revision of the ILAR criteria [5]) carry a fairly severe prognosis, with greater long-term alterations in function and quality of life compared to other forms of juvenile idiopathic arthritis [7]. Early effective treatment is therefore crucial. Studies have established that TNFα antagonist therapy is effective in adults with spondyloarthropathies [3], [4], [8], in juvenile idiopathic arthritis overall [9], and in
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