Department of Pediatric Infectious Disease, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
Clin Rheumatol. 2019 Apr;38(4):1025-1030. doi: 10.1007/s10067-018-4367-9. Epub 2018 Nov 17.
The most effective and concurrently the safest treatment regimen selection is important to provide early control of juvenile idiopathic arthritis (JIA) and to have an acceptable quality of life. The effectivity of biologic agents as well as standard disease-modifying drugs is well documented in treatment of JIA. In spite of their high benefit, these drugs have the risk of serious infections. Herein, we conducted a prospective study to investigate the infectious complications of biologic agents in patients diagnosed with JIA.
Patients on biologic treatment regimen were examined by the pediatric infectious disease specialist in every 2 months during 1-year long.
Throughout the study period, 57% (n:175) of the patients developed infection and 43% (n:132) of them completed this period without any infection. Upper respiratory tract infections which were treated in outpatient clinic were the most common infection. Only three serious infections (two pneumonia, one pleural effusion), which required hospitalization, developed. The infection rate was highest in systemic JIA and lowest in enthesitis-related arthritis (p < 0.001). The total rate of infection development after 1-year period was lowest for etanercept; it was highest for the patients on infliximab treatment (p < 0.001).
We comment that the altered immune system of JIA can be responsible from the serious infections irrespective of immunosuppressive therapy. Biologic agents can be safely used in JIA evaluating the loss and benefit statement.
为了实现幼年特发性关节炎（JIA）的早期控制并提高生活质量，选择最有效且同时最安全的治疗方案至关重要。生物制剂以及标准的疾病修饰药物在 JIA 的治疗中已被证实具有疗效。尽管这些药物疗效显著，但也存在发生严重感染的风险。在此，我们开展了一项前瞻性研究，旨在调查诊断为 JIA 的患者使用生物制剂后的感染并发症。
在为期 1 年的时间里，由儿科传染病专家每 2 个月对接受生物治疗方案的患者进行检查。
在整个研究期间，57%（n：175）的患者发生了感染，43%（n：132）的患者在此期间未发生任何感染。在门诊接受治疗的上呼吸道感染是最常见的感染类型。仅发生了 3 例（2 例肺炎，1 例胸腔积液）需要住院治疗的严重感染。全身型 JIA 的感染发生率最高，附着点炎相关关节炎最低（p<0.001）。经过 1 年时间，依那西普组的感染发生率最低，英夫利昔单抗组最高（p<0.001）。
我们认为，JIA 改变的免疫系统可能导致严重感染，而与免疫抑制治疗无关。在评估生物制剂的风险获益比时，可以安全地将其用于 JIA 的治疗。
