Lazarević Dragana, Nikolić Ivana, Ratković-Janković Marija, Vojinović Jelena
Clinic Of Pediatrics, Clinical Center Niš, Department Of Pediatric Rheumatology, Niš, Serbia.
Medical Faculty, University Of Niš, Pediatrics, Niš, Serbia.
Arch Rheumatol. 2017 Jan 6;32(1):26-31. doi: 10.5606/ArchRheumatol.2017.6060. eCollection 2017 Mar.
This study aims to evaluate the efficacy of adalimumab as a first line biologic agent in specific subtypes of juvenile idiopathic arthritis (JIA) patients with associated uveitis.
We retrospectively analyzed the data of 11 JIA patients (8 males, 3 females; mean age 14.5 years; range 9 to 18 years) with associated uveitis treated with biologic therapy. All patients were diagnosed as oligoarticular/extended oligoarticular or enthesitis-related JIA subtypes, treated with methotrexate, and had active or previous history of uveitis for which adalimumab was prescribed. We tested all patients for anti-nuclear antibody presence and human leukocyte antigen genotype. We assessed disease activity and therapy efficacy by American College of Rheumatology 50%, 70%, and 100% improvement criteria. We evaluated uveitis activity by slit-lamp biomicroscopy and recorded adverse events.
Of the JIA patients, three (27.27%) had oligoarticular/extended oligoarticular JIA and eight (72.73%) had enthesitis-related arthritis. Anti-nuclear antibody positivity was present in 27.27% (all females) while human leukocyte antigen-B51 was determined in 62.5% and human leukocyte antigen-B27 in 12.5% of patients. Mean uveitis duration before adalimumab introduction was 12.3 months. After two years of follow-up, there were no relapses of uveitis and visual acuity was stable while on adalimumab and methotrexate treatment. All patient were gradually tapered and discontinued treatment with topical steroids. Disease activity improved and seven patients (63.64%) achieved American College of Rheumatology 100% response rate (attained remission), while four patients (36.36%) achieved American College of Rheumatology 70% response rate.
Anti-nuclear antibody positivity with oligoarticular/extended oligoarticular and enthesitis-related arthritis JIA subtypes, which are known for their high risk to develop uveitis, may benefit from adalimumab as a first line anti-tumor necrosis factor agent.
本研究旨在评估阿达木单抗作为一线生物制剂，对伴有葡萄膜炎的特定亚型幼年特发性关节炎（JIA）患者的疗效。
我们回顾性分析了11例接受生物治疗的伴有葡萄膜炎的JIA患者（8例男性，3例女性；平均年龄14.5岁；范围9至18岁）的数据。所有患者均被诊断为少关节型/扩展性少关节型或附着点炎相关的JIA亚型，接受过甲氨蝶呤治疗，且有葡萄膜炎的活动期或既往史，为此开具了阿达木单抗。我们对所有患者进行了抗核抗体检测和人类白细胞抗原基因分型。我们依据美国风湿病学会50%、70%和100%改善标准评估疾病活动度和治疗效果。我们通过裂隙灯生物显微镜检查评估葡萄膜炎活动度，并记录不良事件。
在JIA患者中，3例（27.27%）患有少关节型/扩展性少关节型JIA，8例（72.73%）患有附着点炎相关关节炎。抗核抗体阳性率为27.27%（均为女性），而62.5%的患者检测到人类白细胞抗原-B51，12.5%的患者检测到人类白细胞抗原-B27。在引入阿达木单抗之前，葡萄膜炎的平均病程为12.3个月。经过两年的随访，在接受阿达木单抗和甲氨蝶呤治疗期间，葡萄膜炎无复发，视力稳定。所有患者逐渐减少并停用局部类固醇治疗。疾病活动度得到改善，7例患者（63.64%）达到美国风湿病学会100%缓解率（达到缓解），4例患者（36.36%）达到美国风湿病学会70%缓解率。
少关节型/扩展性少关节型及附着点炎相关关节炎JIA亚型具有发生葡萄膜炎的高风险，其抗核抗体阳性可能从阿达木单抗作为一线抗肿瘤坏死因子药物中获益。
