The necessity, efficacy and safety of biologics in juvenile idiopathic arthritis

Abstract

J uvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in children. JIA is arthritis of unknown etiology that begins before the 16th birthday and persists for at least six weeks. JIA is a diagnosis of exclusion and other causes of chronic arthritis should have been excluded before calling a child as having JIA [1-3]. JIA is not a single disease but rather a group of disorders as having chronic arthritis a common feature. Currently used International League of Associations for Rheumatology (ILAR) classification criteria divides JIA into seven subtypes as follows: oligoarticular (persistent or extended) JIA, enthesitis-related arthritis (ERA), ABSTRACT OBJECTIVE: Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in children. Biologics have changed the faith of children with rheumatic diseases. The main objective of this study was to demonstrate the rate of usage, efficacy and safety of biologics in JIA subtypes. METHODS: This retrospective observational cohort study was conducted between May 2010 and September 2017. All children with the diagnosis of JIA and children under a biological agent treatment were recorded into the local registry system. Age, gender, JIA subtype, medications used, the clinical status of the patient, tuberculosis screening results, and side effects observed under biologics were retrieved from the registry. RESULTS: There were 405 patients with the diagnosis of JIA in the cohort. Biologics were used in 123 (30.3%) JIA patients. Subtype frequencies of JIA patients were as follows: persistent oligoarticular JIA (33.6%), enthesitis-related arthritis (29.2%), systemic JIA (13%), rheumatoid factor (RF)-negative polyarticular JIA (13%), extended oligoarticular JIA (4.2%), RF-positive polyarticular JIA (3.4%), psoriatic arthritis (1.8%) and unclassified arthritis (1.8%). The rate of biologic use was high in extended oligoarticular JIA (64.7% of the cases), RF-positive polyarticular JIA (57.1%), psoriatic arthritis (57.1%), RFnegative polyarticular JIA (41.5%), and in systemic JIA (39.6%). Enthesitis-related arthritis (27.1%), persistent oligoarticular JIA (17.6%) and unclassified arthritis (16.6%) patients were the cases that needed a biologic agent in the last order. At the last control, 78.9% of the cases were in remission, while 21.1% of them were active despite biologic treatment. Isoniazid prophylaxis was used in 30.8% of the patients. None of the patients developed active tuberculosis infection under prophylaxis. Adverse events were observed in 18.6% of patients under biologics as recurrent uncomplicated upper respiratory tract infections being the most common. CONCLUSION: Biologics are safe and effective treatment options in children with JIA. Most of the JIA patients with polyarticular involvement require biologics earlier in the disease course. The risk of tuberculosis infection seems not to be increased after appropriate screening and prophylaxis.

Tuberculosis in children and adolescents with rheumatic diseases using biologic agents: an integrative review

“…3,5,8,14,16,17,20,26,31,37 There were only eight specific papers on TB in children with rheumatic diseases using biologics. One was a case-control study 12 that evaluated the risk of TB in children with JIA in Taiwan, two were retrospective studies 4,35 that evaluated the safety of anti-TNFα/ biologics in relation to TB, one was a prospective study 10 that evaluated TB during treatment with biologic agents in a population vaccinated with bacillus Calmette-Guérin (BCG), and four were case reports. 15,22,24,33 Screening for TB before starting biologic therapy was performed in just over half (19/37) of the studies.…”

“…15,22,24,33 Screening for TB before starting biologic therapy was performed in just over half (19/37) of the studies. [3][4][5][8][9][10][11]14,15,19,21,24,27,28,30,[33][34][35][36] Of the 30 cases of TB disease (PTB: 26, EPTB: 4), 8/30 occurred in patients who had been screened before biologic therapy and 22/30 in those not screened. Of the eight specific studies on TB, screening was conducted in six; of the two studies in which there was no report on screening for TB, one is the case that progressed to death.…”

“…52 ADA and tocilizumab (TCZ) were the second and third biologics, respectively, used in patients with JIA. 35 TNFα is a pro-inflammatory cytokine secreted by monocytes, macrophages, and T lymphocytes and develops an important role in the immune response against M. tb, 2,52,53 particularly in the formation and maintenance of granuloma integrity. 52,53 TNFα works synergistically with interferon-gamma, increases the expression of intercellular adhesion molecules (essential for granuloma maintenance), and stimulates the production of the bactericidal compound from intermediates of nitrogen and oxygen.…”

“…52 Since the emergence of biologic agents, there has been an increase in the risk of infections, and patients should be kept under infection surveillance. 10,16,22,35 Before starting biologic drugs, serious infections such as hepatitis B and C, HIV, and TB (active and LTBI) should be excluded or adequate therapeutic planning and treatment of these conditions undertaken whenever possible, before initiating biological therapy. 54 Cakan et al showed that screening with TST and chest X-ray, associated with treatment for LTBI with isoniazid for six months, in cases of TST ≥5 mm, would be sufficient to protect against active TB before initiating the biologic agent.…”

Bukhari Approach to Students in The Context Justice of Transmitter

“…119 Bunun dışında râvînin bilinen ismi veya künyesi dışında meşhûr olmayan bir isim ya da künyesiyle kendisinden rivâyette bulunulması, veyahut da her iki künyesi de biliniyorken o kişiden rivâyet eden râvînin bir künyesini biliyor olması da bu duruma sebep olabilir. 120 Cehâletu'r-râvî iki ihtimali hatıra getirir. Birincisi, kimliğinin; bir diğer ifâdeyle şahsının bilinip tanınmamasıdır.…”