Pediatric Rheumatology Online Journal → June 2003 → Medical Treatment → Anti-tumor necrosis factor therapy→ Abstract #50
                                                                August 2003 → Newer Treatments → Anti-Tumor Necrosis Factor Therapy → Abstract #50

ANTI-TUMOR NECROSIS FACTOR THERAPY LEADS TO IMPROVEMENT OF ENTHESITIS AND SYNOVITIS IN CHILDREN WITH ENTHESITIS-RELATED ARTHRITIS

S. M. L. Tse,¹ A. Doria,¹ P. Babyn,¹ C. Boros,¹ S. Parker,¹ B. M. Feldman,¹ R. M. Laxer.¹

¹Rheumatology and Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada

Peripheral enthesitis in juvenile spondyloarthropathy(JSpA) leads to high morbidity and is often resistant to standard anti-rheumatic therapy. Tumor necrosis factor (TNF) is suggested to be pivotal in entheseal inflammation.We studied the impact of anti-TNF agents in 4 children with enthesitis related arthritis(ILAR criteria) refractory to NSAIDs, DMARDs and corticosteroids. Methods:Our outcomes were within-subject differences in tender entheseal(TEC) and active joints counts(AJC), inflammatory markers, functional assessment(CHAQ) and requirement for DMARDS. Results:4 HLA B27 positive pts(M:F 3:1, mean age:152.6yrs, disease duration:3.02.4yrs) were followed for a min of 6wks after initiation of anti-TNF. At baseline, all had active arthritis and enthesitis resistant to NSAIDS(4), MTX(4), SAS(2), corticosteroids: PO(2), IV pulse(3) and IAS(4), and bisphosphonates(2). In 2 pts, SAS(2), corticosteroids(1), and bisphosphonate(1) were stopped at the initiation of anti-TNF. Two pts received Infliximab for 1yr. Percent and absolute reduction in TEC and AJC from baseline to 6wks, 6mos and 1yr were respectively for pt 1:100%(4)/76%(13), 100%(4)/100%(17), 100%(4)/94%(16) and pt 2:67%(2)/100%(4), 67%(2)/100%(4), 100%(3)/100%(4). The remaining 2 pts received Etanercept for 6wks. Percent and absolute reduction in TEC and AJC from baseline to 6wks was respectively for pt 3:100%(2)/100%(2) and pt 4:100%(7)/67%(2). All inflammatory markers normalized and CHAQ scores improved. Anti-rheumatic requirements decreased in all pts (NSAIDS(4), MTX(3), corticosteroids(1) and bisphosphonates(1)). To visualize the entheseal response, pt 3 was imaged with gadolinium-enhanced MRI and colour/power Doppler US before and 6wks after therapy. Both modalities showed a decrease in entheseal inflammation. Conclusion:Anti-TNF therapy is a potential treatment for enthesitis in JSpA pts. Future prospective studies are required to examine the long-term outcomes of anti-TNF for this cohort.