Therapeutic effects of the anti-tumor necrosis factor monoclonal antibody, infliximab, in four children with refractory juvenile idiopathic arthritis.
OBJECTIVE
To report the results of treatment with infliximab in patients with refractory juvenile idiopathic arthritis (JIA).


METHODS
A prospective study of four children with refractory JIA was carried out. Infliximab (100 mg) was administered in weeks 0, 2 and 6. Subsequently, the drug was administered every 8 weeks. The following parameters were assessed at the beginning and at the end of the follow-up period: number of joints with active arthritis, number of joints with a limited range of motion, physician overall assessment of disease activity, parent assessment of the child's overall well-being, pain assessment scores, and erythrocyte sedimentation rate. Improvement was rated according to the definition of the American College of Rheumatology (ACR 30). Paired sample tests were used for statistical analysis.


RESULTS
Three girls and one boy aged between 10 and 16 years old with a history of JIA ranging from 1 to 9 years were included. The patients received infliximab for a period of 11 to 33 months (average 22 months). There was a significant decrease in the number of swollen joints (p < 0.05), joints with a limited range of movement (p < 0.04), pain score assessment (p < 0.005), physician overall assessment (p = 0.002), maternal evaluation (p < 0.001), the patient's own evaluation (p < 0.001), and duration of morning stiffness (p < 0.001). Both steroids and methotrexate dosages were reduced and no adverse effects or infections were registered.


CONCLUSIONS
Infliximab improved joint inflammatory indexes and clinical assessments. This improvement increased the quality of life of the patients and their families, suggesting that the use of biological therapy is a good option in refractory JIA.
Norambuena R
X
X
Pediatric Unit, Hospital Dr, Exequiel Gonzalez Cortes, Chile.
Mallol
J
J
Ríos M
G
G
Quevedo R
F
F
Quezada L
A
A
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D001799:Blood Sedimentation; D002648:Child; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D010147:Pain Measurement; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D008727:Methotrexate