title: A prospective study comparing infection risk and disease activity in children with juvenile idiopathic arthritis treated with and without tumor necrosis factor-alpha inhibitors.
abstract: Tumor necrosis factor-alpha (TNF-α) inhibitors are effective treatment for juvenile idiopathic arthritis (JIA) but may increase infection rates. However, active JIA may also render patients vulnerable to infection. In this study, we prospectively assessed infection rates in JIA patients treated with and without TNF-α inhibitors and correlated disease activity with infection risk. TNF-α inhibitor-naïve JIA subjects were followed up for 12 months. Subjects initiated on TNF-α inhibitors after enrollment were analyzed in the TNF group. Subjects treated without TNF-α inhibitors were analyzed in the non-TNF group. Questionnaires captured mild or severe infections. JIA disease activity by Childhood Health Assessment Questionnaire (CHAQ) disability index/pain score and physician joint count/global assessment was recorded. Twenty TNF and 36 non-TNF subjects were analyzed. The total infection rate ratio for TNF versus non-TNF group subjects was 1.14 (95% CI, 0.78-1.66; p = 0.51). The average rate of infections per month was 0.29 for TNF and 0.24 for non-TNF subjects. No severe infections or hospitalizations occurred in either group. Secondary infectious outcomes were also similar between groups. Controlling for study group, an increase in CHAQ pain score correlated with an increase in several infectious outcome measures. Our results suggest no difference in infection rates between JIA subjects treated with and without TNF-α inhibitors. Additionally, JIA disease activity may have contributed to infection risk in our cohort, irrespective of immunosuppressive therapy. Future analysis of the relationship between treatment regimens, disease activity, and infection rates may help to further delineate predictors of infection risk in JIA patients.
authors.affiliation: Department of Pediatric Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA, heather.marie.walters@gmail.com.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Walters
authors.forename: Nancy
authors.initials: N
authors.lastname: Pan
authors.forename: Thomas J A
authors.initials: TJ
authors.lastname: Lehman
authors.forename: Alexa
authors.initials: A
authors.lastname: Adams
authors.forename: Wei-Ti
authors.initials: WT
authors.lastname: Huang
authors.forename: Lemonia
authors.initials: L
authors.lastname: Sitaras
authors.forename: Susanna
authors.initials: S
authors.lastname: Cunningham-Rundles
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: Sima S
authors.initials: SS
authors.lastname: Toussi
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects; D000293:Adolescent; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001171:Arthritis, Juvenile / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D000068800:Etanercept / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D007239:Infections / Q000209:etiology*; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D000068800:Etanercept