title: Non-systemic juvenile idiopathic arthritis outcome after reaching clinical remission with anti-TNF-α therapy: a clinical practice observational study of patients who discontinued treatment.
abstract: TNF-alpha-blocking agents (anti-TNF) used in juvenile idiopathic arthritis (JIA) are well established; however, time to withdraw is unclear. Neither prolonged nor tapering treatment seems to influence risk of relapse. Our aim was to assess relapse percentage after anti-TNF withdrawal of our non-systemic JIA patients after reaching clinical remission. A retrospective review of our non-systemic JIA patients in whom anti-TNF had been withdrawn due to inactive disease was achieved, between December 2000 and November 2011. We analyzed percentages of relapse according to JIA categories and antinuclear antibodies (ANA) positivity. n = 18 patients were included. Eighty-two percentage of patients relapsed after treatment withdrawal, and mean time to relapse was 3.04 months (SD 2.03). The percentage of relapse after anti-TNF discontinuation in the main JIA category was 88 % of negative rheumatoid factor polyarticular JIA and 80 % of persistent oligoarticular JIA. We did not find significant statistical differences according to ANA positivity (9 of 14 were ANA positive), and mean time to relapse (days) was 85.0 (SD 69.4) for ANA-positive versus 102.4 (SD 47.7) for ANA-negative patients (p = NS). Relapse percentage following anti-TNF discontinuation was high (82 %) and occurred within the first 3 months after it. No relationship regarding JIA subtype and ANA positivity was found.
authors.affiliation: Pediatric Rheumatology Unit, Hospital Sant Joan de Déu-Universitat Barcelona, Passeig Sant Joan 2, 08950, Esplugues de Llobregat, Barcelona, (Catalunya), Spain, eiglesias@hsjdbcn.org.
authors.forename: Estíbaliz
authors.initials: E
authors.lastname: Iglesias
authors.forename: Vicenç
authors.initials: V
authors.lastname: Torrente-Segarra
authors.forename: Rosa
authors.initials: R
authors.lastname: Bou
authors.forename: Silvia
authors.initials: S
authors.lastname: Ricart
authors.forename: María Isabel
authors.initials: MI
authors.lastname: González
authors.forename: Judith
authors.initials: J
authors.lastname: Sánchez
authors.forename: Joan
authors.initials: J
authors.lastname: Calzada
authors.forename: Jordi
authors.initials: J
authors.lastname: Antón
mesh_terms: D000974:Antibodies, Antinuclear / Q000097:blood; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001168:Arthritis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D001171:Arthritis, Juvenile / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D004334:Drug Administration Schedule; D006801:Humans; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012217:Rheumatoid Factor / Q000097:blood; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000974:Antibodies, Antinuclear; D018501:Antirheumatic Agents; D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha; D012217:Rheumatoid Factor