Objective. To report the 2-year efficacy and safety of tocilizumab (TCZ) in patients with polyarticular-course juvenile idiopathic arthritis (JIA). Methods. Patients ages 2-17 years with active polyarticular-course JIA, in whom treatment with methotrexate was unsuccessful, received 16 weeks of open-label intravenous TCZ in part 1 (once every 4 weeks: 8 mg/kg or 10 mg/kg for body weight [BW] <30 kg; 8 mg/kg for BW ≥30 kg). Assessments were based on the JIA-American College of Rheumatology (ACR) response (defined as percentage of improvement in ≥3 of the 6 JIA core response variables [CRVs]). Patients with at least a JIA-ACR30 response (defined as ≥30% improvement in ≥3 of the 6 JIA CRVs without worsening in >1 of the remaining JIA CRVs by >30%) at week 16 were randomly assigned (1:1) to receive TCZ or placebo in part 2. Patients remained in part 2 until either week 40 or the occurrence of JIA flare. Upon starting part 3, all patients received open-label TCZ. At week 104 of the study, efficacy was assessed using JIA-ACR50/70/90 response rates (defined as 50%, 70%, or 90% improvement, respectively), achievement of inactive disease, and the Juvenile Arthritis Disease Activity Score in 71 joints (JADAS-71). Safety was assessed in the all-exposure population per 100 patient-years of exposure. Results. Overall, 188 patients entered part 1, 166 patients entered part 2, and 160 patients entered part 3. By week 104, among the 188 patients in the modified intent-to-treat group who received TCZ, JIA-ACR50/70/90 response rates were 80.3%/77.1%/59.6%, respectively, the median JADAS-71 score decreased from 3.6 at week 40 to 0.7 at week 104, 51.1% of patients had achieved inactive disease, and 31 of 66 patients who had been receiving glucocorticoids discontinued them. Adverse event (AE) and serious AE rates were 406.5 per 100 patient-years and 11.1 per 100 patient-years, respectively. The infection rate was 151.4 per 100 patient-years, and the serious infection rate was 5.2 per 100 patient-years. Conclusion. Patients treated with TCZ for polyarticular-course JIA showed high-level disease control for up to 2 years. The TCZ safety profile was consistent with that previously reported.

Objetivos: Evaluar las causas más frecuentes de atenciones por patología reumatológica en el servicio de emergencias de un hospital pediátrico peruano de tercer nivel. Pacientes y Métodos: Se llevó a cabo un estudio descriptivo, observacional y retrospectivo mediante la revisión de la base de datos y registros del servicio de emergencias del hospital, correspondientes al periodo comprendido entre enero 2012 y junio 2014, seleccionándose las atenciones debidas a patología reumatológica. Los datos fueron procesados mediante el programa estadístico SPSS 16.0. Resultados: Durante el periodo evaluado el número total de atenciones en el servicio de emergencias fue de 133484, correspondiendo 835 casos (0,63%) a diagnósticos reumatológicos según la Clasificación Internacional de Enfermedades 10° (CIE-10). La mayoría de los pacientes fueron hombres (450, 53,08%) y la distribución por grupos etáreos fue: 1-4 años 327 (39,16%), 5-9 años 251 (30,02%), 10-14 años 158 (18,98%), mayores de 15 años 68 (8,11%) y menores de un año 32 (3,77%). Las 5 primeras causas de atenciones reumatológicas, de acuerdo al CIE-10, durante este período fueron: artritis reactiva 173 casos (20,72%), dolor en articulación 168 (20,12%), púrpura de Schönlein-Henoch (púrpura alérgica) 107 (12,81%), artritis séptica (artritis piógena) 89 (10,67%) y mialgias 77 (9,22%). El número de atenciones por problemas reumatológicos se mantuvo estable a través del tiempo, siendo de 325 a 345 casos por año. Conclusiones: Las atenciones debidas a patología reumatológica en el servicio de emergencias de un hospital pediátrico terciario como el 2016