ANTI-TNF-ALPHA BLOCKING AGENTS IN JUVENILE PSORIATIC ARTHRITIS; IS IT EFFECTIVE?

Background: In adult-onset Psoriatic Arthritis (PsA) anti-TNF therapies seem highly effective and safe [1]. Many studies have been done to the efficacy and safety of anti-TNF blocking agents in JIA patients with a poly-articular course, but until now no research has focused on Juvenile PsA (JPsA) only. Objectives: To evaluate the effectiveness of anti-TNF-alpha blocking agents in JPsA-patients. Methods: Prospective ongoing multicentre, observational study of all Dutch JIA patients using biological agents since 1999, with until now more than 300 JIA-patients included. Patient and disease characteristics are collected at baseline. At start of treatment, after three months, 15 months and thereafter yearly variables of the JIA disease activity score; physician's global (VAS), Childhood Health Assessment Questionnaire (CHAQ), including global assessment of well being (VAS), number of active and limited joints and ESR, are retrieved. Results: In our registry 18 patients according to the JPsA-subtype are included; 67% female, 83% polyarticular course, median age at onset JPsA 11.3 years (range 3.3-14.6 years), median disease duration at start anti-TNF-alpha 24 months (range 2-55 months) with a median follow-up since start anti-TNF of 27 months (range 3-62 months). Seventeen patients started etanercept, one adalumimab. One patient switched from etanercept to adalumimab because of a severe uveitis, though changed back to etanercept after six weeks due to a relapse of the arthritis. No patients switched to other biological agents. All except one patient showed impressive improvements. Disease Activity Variables at start and after 3 and 15 months of anti-TNF treatment are shown in table 1. None discontinued anti-TNF due to inefficacy. Nine patients (50%) reached remission. Of these patients 7 discontinued treatment, 6 flared thereafter and needed to restart anti-TNF treatment. During treatment two patients showed a worsening and three patients an improvement of their pre-existing psoriatic skin lesions and one patient developed psoriatic skin lesions for the first time. Table 1. Disease Activity Variables at start, 3 and 15 months Disease Activity variablesStart3 months15 months Physician's global (0-100)45 (8-90)10 (0-43)0 (0-50) CHAQ1.5 (0.4-3.0)1.0 (0.1-2.3)0.5 (0.3-2.1) Global assessment of wellbeing (0-100)51 (8-98)17.5 (0-85)12.5 (0-46) Active joints10 (2-46)2 (0-25)0 (0-8) Limited joints7 (1-31)1 (0-28)0 (0-13) ESR (mm/h)12 (5-78)6 (2-46)6 (2-88) Conclusion: Anti-TNF therapy in Juvenile Psoriatic Arthritis is very effective. Many patients who reached remission flared after discontinuation of anti-TNF blocking agents. This emphasizes the need for further investigation for optimal duration of therapy. Surprisingly during anti-TNF treatment not all psoriatic skin lesions improved and even one patient was diagnosed with psoriatic skin lesions. References: 1. Saad AA, Ashcroft DM, Watson KD, Symmons DP, Noyce PR, Hyrich KL. Efficacy and safety of anti-TNF therapies in psoriatic arthritis: an observational study from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford, England). Jan 7. Disclosure of Interest: None declaredCitation: Annals of the Rheumatic Diseases, volume 69, supplement 3, year 2010, page 636Session: Paediatric rheumatology (Poster Presentations )