title: Tumour necrosis factor-blocking agents in persistent oligoarticular juvenile idiopathic arthritis: results from the Dutch Arthritis and Biologicals in Children Register.
abstract: OBJECTIVE
  Because TNF inhibitors are not approved for persistent oligoarticular JIA (oJIA), although they are used off-label, we evaluated their effectiveness in patients in this category.
  
  
  METHODS
  Persistent oJIA patients were selected from the Dutch Arthritis and Biologicals in Children (ABC) register, an ongoing multicentre prospective study that aims to include all Dutch children with JIA using biologic agents. Response was assessed by the JIA core-set disease activity variables and modified Wallace criteria for inactive disease.
  
  
  RESULTS
  Until February 2011, 16 persistent oJIA patients (68.8% females) had been included in the register. Median age of onset was 8.4 years [interquartile range (IQR) 2.1-13.5 years]; history of uveitis in 18.8%; ANA-positive 56.3%. All had previously used MTX, and 81.3% had used IA CSs. Median follow-up after the introduction of biologic treatment was 13.7 months (IQR 8.3-16.7 months). Fourteen patients started etanercept and two patients who had active arthritis as well as uveitis started adalimumab. Although patients with persistent oJIA had few affected joints [median of two active joints at the start of biologic (IQR 1-3)], the patient/parent assessments of pain [median visual analogue score (VAS) 51 (IQR 1-64)] and well-being [median VAS 44 (IQR 6-66)] were high. Additionally, their physician evaluated the disease activity as moderately high [median VAS 36 (IQR 4-65)]. After 3 months this decreased to 0 (IQR 0-30) and 63% achieved inactive disease. After 15 months the disease was inactive in 9/10 observed patients. TNF inhibitors were tolerated well.
  
  
  CONCLUSIONS
  TNF blocking agents seem an effective and justifiable option in persistent oJIA when treatment with IA CS injections and MTX has failed.
authors.affiliation: Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands. j.anink@erasmusmc.nl
authors.forename: Janneke
authors.initials: J
authors.lastname: Anink
authors.forename: Marieke H
authors.initials: MH
authors.lastname: Otten
authors.forename: Femke H M
authors.initials: FH
authors.lastname: Prince
authors.forename: Esther P A H
authors.initials: EP
authors.lastname: Hoppenreijs
authors.forename: Nico M
authors.initials: NM
authors.lastname: Wulffraat
authors.forename: Joost F
authors.initials: JF
authors.lastname: Swart
authors.forename: Rebecca
authors.initials: R
authors.lastname: ten Cate
authors.forename: Marion A J
authors.initials: MA
authors.lastname: van Rossum
authors.forename: J Merlijn
authors.initials: JM
authors.lastname: van den Berg
authors.forename: Koert M
authors.initials: KM
authors.lastname: Dolman
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Koopman-Keemink
authors.forename: Wineke
authors.initials: W
authors.lastname: Armbrust
authors.forename: Sylvia
authors.initials: S
authors.lastname: Kamphuis
authors.forename: Philomine A
authors.initials: PA
authors.lastname: van Pelt
authors.forename: Simone L
authors.initials: SL
authors.lastname: Gorter
authors.forename: Lisette W A
authors.initials: LW
authors.lastname: van Suijlekom-Smit
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use; D002648:Child; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D009426:Netherlands; D010147:Pain Measurement; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001688:Biological Products; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D000068800:Etanercept