Naproxen-induced pseudoporphyria in patients with juvenile rheumatoid arthritis

Lang, Bianca; Finlayson, Laura

doi:10.1016/s0022-3476(05)83149-x

Cited by 59 publications

(20 citation statements)

References 9 publications

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“…13 Pseudoporphyria may occur with all of the propionic acid NSAIDs and may be more common with naproxen sodium, especially in fair-skinned young patients. 26 Because of the lack of a clear-cut consensus on the optimal NSAID for patients with JRA, many clinicians choose an NSAID on the basis of considerations such as dosing schedule, patient preference, or medication taste.…”

Section: Nsaidsmentioning

confidence: 99%

Current Treatment of Juvenile Rheumatoid Arthritis

Ilowite

2002

Pediatrics

121

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Prognostic factors in juvenile rheumatoid arthritis (JRA) include polyarticular onset, polyarticular disease course, and rheumatoid factor positivity; in the systemic onset subtype, persistence of systemic features at 6 months after onset confers a worse prognosis. Timely diagnosis and appropriate aggressive treatment of patients with poor prognostic features improve quality of life and outcome. After nonsteroidal anti-inflammatory drugs, methotrexate is the most commonly used second-line agent. However, approximately one third of patients do not respond to methotrexate adequately. Randomized, placebo-controlled, clinical trials in patients with JRA are few, but one such trial with the tumor necrosis factor inhibitor etanercept shows that this drug is effective and well-tolerated. Other recently approved agents for rheumatoid arthritis, including infliximab, leflunomide, celecoxib, and rofecoxib, have not been adequately studied in pediatric patients, and the role of these agents in children with JRA remains to be determined.

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Section: Nsaidsmentioning

confidence: 99%

Current Treatment of Juvenile Rheumatoid Arthritis

Ilowite

2002

Pediatrics

121

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“…This finding is in accordance with those of a few previous studies conducted in considerably smaller numbers of children. Lang and Finlayson [25] first reported a prevalence of 12% in their cohort of 74 naproxen-treated patients in Canada. De Silva and colleagues [10] found a similar prevalence of 10.9% in their group of 64 children with JIA in Scotland.…”

Section: Discussionmentioning

confidence: 99%

“…ANA presence and sex seemed not to influence risk. In their smaller cohorts, de Silva and coworkers [10] and Lang and Finlayson [25] did not observe a significant difference in age at onset, subtype of JIA, presence of ANAs, or sex when they compared their PP patients with the remaining patients. In contrast, Levy and colleagues [27] detected increased ANA titres in 86% of children with PP.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few studies of PP have been performed in children on long-term NSAID treatment. Thus far these studies have yielded a prevalence of PP between 10% and 12% in these patients, with fair skin and blue/grey eye colour established as risk factors [25]. Facial scarring improves slowly with time, but new skin lesions can appear even for weeks and months after discontinuation of treatment [9].…”

Section: Introductionmentioning

confidence: 99%

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Early onset pauciarticular arthritis is the major risk factor for naproxen-induced pseudoporphyria in juvenile idiopathic arthritis

et al. 2007

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Pseudoporphyria (PP) is characterized by skin fragility, blistering and scarring in sun-exposed skin areas without abnormalities in porphyrin metabolism. The phenylpropionic acid derivative group of nonsteroidal anti-inflammatory drugs, especially naproxen, is known to cause PP. Naproxen is currently one of the most prescribed drugs in the therapy of juvenile idiopathic arthritis (JIA). The prevalence of PP was determined in a 9-year retrospective study of children with JIA and associated diseases. In addition, we prospectively studied the incidence of PP in 196 patients (127 girls and 69 boys) with JIA and associated diseases treated with naproxen from July 2001 to March 2002. We compared these data with those from a matched control group with JIA and associated diseases not treated with naproxen in order to identify risk factors for development of PP. The incidence of PP in the group of children taking naproxen was 11.4%. PP was particularly frequent in children with the early-onset pauciarticular subtype of JIA (mean age 4.5 years). PP was associated with signs of disease activity, such as reduced haemoglobin (<11.75 g/dl), and increased leucocyte counts (>10,400/μl) and erythocyte sedimentation rate (>26 mm/hour). Comedications, especially chloroquine intake, appeared to be additional risk factors. The mean duration of naproxen therapy before the onset of PP was 18.1 months, and most children with PP developed their lesions within the first 2 years of naproxen treatment. JIA disease activity seems to be a confounding factor for PP. In particular, patients with earlyonset pauciarticular JIA patients who have significant inflammation appear to be prone to developing PP upon treatment with naproxen.

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“…44 Caregivers should be informed of this risk of permanent scarring. 45,46 Naproxen is the most frequently associated NSAID; 44 however, there are reports of pseudoporphyria associated with nabumetone, 47,48 celecoxib, 49 and rofecoxib, 50 among others. 44 Toxicity profiles vary by NSAID and patient factors.…”

Section: Nonsteroidal Antiinflammatory Drugsmentioning

confidence: 99%

Pediatric Rheumatology for the Adult Rheumatologist I

DeWitt

Sherry

Cron

2005

JCR: Journal of Clinical Rheumatology

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Treatment of children with rheumatic diseases has advanced with novel therapeutics and the use of early aggressive treatment to achieve better long-term functional outcome. Many of the current treatments in pediatric rheumatology are based on studies in adults on medications without U.S. Food and Drug Administration labeling for pediatric use. This is not ideal because the pharmacokinetics (absorption, distribution, metabolism, and elimination) of many medications when used in children vary according to age, somatic growth, sexual maturity, and ontogeny of drug-metabolizing enzymes. Special dosing, administration considerations, and toxicity screening are reviewed for the more commonly used medications. Vaccinations for children on antirheumatic drugs are also discussed. Continued study of the long-term impact of medications and biologic treatments on children is necessary, but given the paucity of children with rheumatic diseases, this will require multicentered trials and collaborations. Lastly, this article reviews recent regulatory and legislative action on pediatric drug testing. Passage of the Pediatric Research Equity Act of 2003, which requires testing of pharmaceuticals in children, will facilitate more rational use of drugs in pediatric rheumatic diseases in the future.

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Naproxen-induced pseudoporphyria in patients with juvenile rheumatoid arthritis

Cited by 59 publications

References 9 publications

Current Treatment of Juvenile Rheumatoid Arthritis

Current Treatment of Juvenile Rheumatoid Arthritis

Early onset pauciarticular arthritis is the major risk factor for naproxen-induced pseudoporphyria in juvenile idiopathic arthritis

Pediatric Rheumatology for the Adult Rheumatologist I

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