Department of Paediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
Ann Rheum Dis. 2011 Feb;70(2):337-40. doi: 10.1136/ard.2010.135731. Epub 2010 Nov 10.
To evaluate the effectiveness of tumour necrosis factor (TNF) blockers in juvenile psoriatic arthritis (JPsA).
The study was a prospective ongoing multicentre, observational study of all Dutch juvenile idiopathic arthritis (JIA) patients using biologicals. The response of arthritis was assessed by American College of Rheumatology (ACR) paediatric response and Wallace inactive disease criteria. The response of psoriatic skin lesions was scored by a 5-point scale.
Eighteen JPsA patients (72% female, median age onset 11.1 (range 3.3-14.6) years, 50% psoriatic skin lesions, 39% nail pitting, 22% dactylitis) were studied. The median follow-up time since starting anti-TNFα was 26 (range 3-62) months. Seventeen patients started on etanercept and one started on adalimumab. After 3 months of treatment 83% of the patients achieved ACR30 response, increasing to 100% after 15 months. Inactive disease reached in 67% after 39 months. There was no discontinuation because of inefficacy. Six patients discontinued treatment after a good clinical response. However, five patients flared and restarted treatment, all with a good response. During treatment four patients (two JPsA and two JIA patients with other subtypes) developed de novo psoriasis. In four of the nine patients the pre-existing psoriatic skin lesions improved.
Anti-TNFα therapy in JPsA seems effective in treating arthritis. However, in most patients the arthritis flared up after treatment discontinuation, emphasising the need to investigate optimal therapy duration. The psoriatic skin lesions did not respond well and four patients developed de novo psoriasis.
评估肿瘤坏死因子（TNF）阻滞剂在幼年特发性关节炎（JPsA）中的疗效。
这是一项针对所有使用生物制剂的荷兰幼年特发性关节炎（JIA）患者的前瞻性、持续多中心、观察性研究。关节炎的反应通过美国风湿病学会（ACR）儿科反应和 Wallace 无活动疾病标准进行评估。银屑病皮损的反应通过 5 分制评分。
研究纳入了 18 例 JPsA 患者（72%为女性，中位发病年龄为 11.1 岁（范围 3.3-14.6 岁），50%有银屑病皮损，39%有指甲凹陷，22%有指（趾）炎）。自开始使用抗 TNFα 以来的中位随访时间为 26（范围 3-62）个月。17 例患者开始使用依那西普，1 例开始使用阿达木单抗。治疗 3 个月后，83%的患者达到 ACR30 反应，15 个月后增至 100%。39 个月后 67%的患者达到无活动疾病。没有因疗效不佳而停药。6 例患者在临床反应良好后停药。然而，5 例患者病情复发并重新开始治疗，均有良好的反应。在治疗期间，4 名患者（2 名 JPsA 患者和 2 名 JIA 患者有其他亚型）出现了新发性银屑病。9 例患者中，4 例患者原有银屑病皮损改善。
在 JPsA 中，抗 TNFα 治疗似乎对关节炎有效。然而，在大多数患者中，关节炎在停药后会再次发作，这强调了需要研究最佳治疗持续时间。银屑病皮损反应不佳，4 例患者出现新发性银屑病。
