Pediatric Rheumatology Online Journal → June 2003 → Medical Treatment → Anti-tumor necrosis factor therapy→ Abstract #59
                                                                August 2003 → Newer Treatments → Anti-Tumor Necrosis Factor Therapy → Abstract #59

TREATMENT OF JUVENILE ONSET IDIOPATHIC ARTHRITIS WITH INFLIXIMAB

H. Ozdogan,¹ F. Gogus, S. Masatlioglu, D. Cevirgen, G. Hatemi, E. Seyahi

¹Rheumatology, Cerrahpasa Medical Faculty, Istanbul, Turkey

Infliximab was administered to 15 patients with JIA who had failed to respond to methotrexate (MTX) and prednisolone, or a combination therapy. It was added to previously started MTX and prednisolone. The mean age of the patients was 17 years (8-29), the mean disease onset 8.5 (2-16), and the mean disease duration was 8.8 years (3-17). Six had systemic, 5 poly-, 1 oligoarticular onset disease and 3 enthesitis-related arthritis (ERA), with a polyarticular course in 11 and systemic in 1 patient. Two of the patients had secondary amyloidosis and one ERA-patient had concomitant familial Mediterranean fever. Infliximab was administered intravenously at weeks 0,2,6 and every 8 weeks thereafter, in an outpatient setting of an university clinic. The mean infliximab dose was 4 mg/kg. and the mean number of infusions was 6.5 (4-15). CRP, ESR, patient"s and doctor"s global assesments were evaluated before every infusion.
A significant improvement in the clinical findings and acute phase response was observed after the first 2 infusions. The mean ESR had decreased from 49.8±22 to 13± 10 mm/h, CRP from 42.4±34.9 to 3.5±0.7 mg/dl. However the ESR and CRP levels tended to rise after the 4^th infusion. No proteinuria was detected after the 13^th infusion in the patient with secondary amyloidosis . One patient with poly- disease and the other with ERA had complete remission after the 6^th and 4^th infusions. The therapy was stopped in one patient due to angioneurotic edema during the 5^th infusion. One patient developed zona zoster infection after the 4^th therapy. Infliximab was restarted after 3 months without further complications. The therapy was stopped in another patient after the 4^th infusion because of subjective complaints of chest tightness, dizziness, palpitation.
The significant improvement in the clinical and acute phase response starts after the 2^nd infusion of infliximab. Although the number of patients are few, there seems to be a tendency for a better response in ERA patients and in patients with a disease duration of less than 10 years.