title: Etanercept treatment for children with refractory juvenile idiopathic arthritis.
abstract: BACKGROUND
  Etanercept has been shown to be an effective treatment for juvenile idiopathic arthritis (JIA). In this study, we evaluated the effectiveness of etanercept therapy in the treatment of refractory JIA.
  
  
  METHODS
  This was a retrospective analysis of 11 patients with refractory JIA (polyarticular type n=7; pauciarticular type, n=2; systemic type, n=2) who received treatment with etanercept during the period 2005-2009 in a medical center. The indications for etanercept treatment included persistent fever, arthritis/arthralgia, or elevated levels of inflammatory mediators after treatment with methotrexate and/or prednisolone for more than 6 months. The patients were treated with etanercept (0.4 mg/kg, with maximal 25mg, subcutaneously, twice a week) for a total of 12 months.
  
  
  RESULTS
  The degree of arthritis/arthralgia improved (range of motion and painful sensation of involved joints), and the levels of inflammatory markers (C-reactive protein and erythrocyte sedimentation rate) decreased progressively in 10 of the 11 patients (p<0.05) at 1-, 3-, 5-, and 12-month follow-up after treatment with etanercept. Mean hemoglobin levels significantly increased, whereas mean platelet counts decreased after etanercept treatment (p<0.05). Only one patient with systemic type of JIA failed to respond to the treatment after 6 weeks of etanercept therapy. Methotrexate, prednisolone, and other immunosuppressive drugs were successfully discontinued after a mean of 2.5 months (range, 1-5 months) of etanercept therapy in the 10 patients who responded to etanercept treatment.
  
  
  CONCLUSIONS
  Etanercept is beneficial for patients with polyarticular and pauciarticular type of JIA that is refractory to conventional treatment but less beneficial for systemic type of JIA.
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
authors.forename: Ho-Chang
authors.initials: HC
authors.lastname: Kuo
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan; Graduate Institute of Clinical Medical Science, Chang Gung University, Kaohsiung, Taiwan.
authors.forename: Hong-Ren
authors.initials: HR
authors.lastname: Yu
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
authors.forename: Chih-Chiang
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
authors.forename: Ling-Sai
authors.initials: LS
authors.lastname: Chang
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan; Graduate Institute of Clinical Medical Science, Chang Gung University, Kaohsiung, Taiwan.
authors.forename: Kuender D
authors.initials: KD
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D000068800:Etanercept / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D000068800:Etanercept