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BackgroundJuvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children with wide variety in its clinical profile.ObjectivesThe aim of our study was to describe the epidemiological, clinical, paraclinical and management aspects of JIA among Tunisian children.MethodsThis is a monocentric retrospective and observational study including children who met the ILAR criteria for the diagnosis of JIA. They were collected from the rheumatology department of Farhat Hached Hospital of Sousse in Tunisia.ResultsOut of the 55 included children, 27 (49.1%) were boys and 28 (50.9%) were girls. The mean age was 13.6 years. The mean age of onset of JIA was 6.4 years [3 months-16 years]. The mean duration of JIA progression was 4.4 years. The predominant subtypes of JIA were the seronegative polyarticular form (21 cases, 38.2%), the seronegative oligoarticular form and juvenile spondyloarthritis (9 cases, 16.4% each). The other forms were: seropositive polyarthritis (7 cases, 12.7%), systemic onset JIA (SOJIA) and psoriatic arthritis (4 cases, 7.3% for each) and arthritis with enthesitis (1 case, 1.8%). Arthritis was present in all patients. Wrist followed by knee were the most affected joints in all subtypes. Fever, lymphadenopathy, hepatosplenomegaly and rash were exclusive to patients with SOJIA. Uveitis (2 cases, 3.6%) and anti-nuclear antibodies (ANA) positivity (1 case, 1.8%) were rare. Biological inflammatory syndrome was found in 65.5% of cases. The means of ESR and CRP were 42.4 mm/h and 28.8 mg/L respectively. Anemia was found in 56.4% of cases. Standard X rays revealed carpitis in 4 cases (7.2%) and bone erosions in 9 cases (16.4%). Coxitis was present in 30.9% of the patients. Concerning treatment, our patients received non steroidal anti-inflammatory drugs (61.8%), oral corticosteroids (67.3%), and pulse steroid therapy in 47.3% of cases. Methotrexate was used for 65.5% of patients. Twenty-four patients (41.8%) were treated with biologics. Delayed growth as a complication of the JIA was observed in 8 cases (14.5%). Twenty-three patients (41.8%) developed joint deformities.ConclusionJIA has heterogeneous presentations with a challenging diagnosis in rheumatology practice. In our study, the seronegative polyarticular form was the most common subtype of JIA. Inflammatory syndrome, coxitis and deformities were frequent whereas uveitis and ANA positivity were rare findings in our population.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundJuvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children under the age of 16. Biologic therapy significantly improved the management and prognosis of this disease.ObjectivesWe aimed to evaluate the indications, clinical efficacy and safety of biotherapy for the treatment of JIA in a tunisian population.MethodsThis is a monocentric retrospective and observational study including patients followed for JIA (ILAR criteria) in the Rheumatology department of Sousse in Tunisia.ResultsFifty-five children (28 girls and 27 boys) were included. The mean age was 13.6 years. The predominant subtypes of JIA were the seronegative polyarticular JIA (38.2%), and the seronegative oligoarticular form and juvenile spondyloarthritis (16.4% each). Besides biologics, our patients received non steroidal anti-inflammatory drugs (61.8%), oral corticosteroids (67.3%), and pulse steroid therapy in 47.3% of cases. Methotrexate was used for 65.5% of patients. Twenty-four patients were treated with biologics, with a prevalence of 41.8%. The mean age at the beginning of biotherapy was 12 years, with a mean time for initiation of 5 years. The main indications were the first and second-line treatments failure (29.1%) and their side effects (12.7%). The most frequently used biologics were TNF alpha blockers: Etanercept (9 patients), Infliximab (6 patients), Certolizumab and Adalimumab (2 patients each). Anti-Interleukin-6 (Tocilizumab) was used in the systemic JIA form for 4 patients. The mean duration of treatment with biologics was 3.55 years. A trend towards lower disease activity was observed with steroid therapy stopped in 25%. Five patients switched biologics. The overall safety profile was good. No serious adverse drug events occurred except anaphylaxis in 2 cases: 1 with Tocilizumab and one with Infliximab. The other side effects were hepatic toxicity with elevated transaminases (2 patients) and moderate cutaneous infection (1 patient).ConclusionBiologics have provided interesting new therapeutic alternatives in Tunisian patients with JIA, despite the delay of their initiation. However, the long-term side effects of modulating the immune system are not yet fully understood in this young population.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.