Department of Pediatric Rheumatology, Abderrahim Harouchi Children University Hospital, University Hospital Center Ibn Rochd, Casablanca, Morocco.
Hassan II University of Medicine and Pharmacy, Casablanca, Morocco.
Pan Afr Med J. 2022 Feb 16;41:135. doi: 10.11604/pamj.2022.41.135.27377. eCollection 2022.
In this study, we aimed to evaluate the clinicobiological findings and the biotherapy treatment response of Moroccan patients with juvenile idiopathic arthritis (JIA), and compare our results with those of populations of the same or different ethnicity. This retrospective cross-sectional study included patients aged 1-14 years, diagnosed between 2003 and 2018 with JIA according to the International League of Associations for Rheumatology (ILAR) 2004 revised criteria, who received biologics and who followed up during the year 2018 in the day hospital of our single-center tertiary pediatric rheumatology unit. Among 59 patients, 53% had systemic JIA, 29% seronegative polyarticular JIA, 8% arthritis-related enthesitis, 5% seropositive polyarticular JIA, 3% oligoarthritis and 2% psoriatic arthritis. Tocilizumab was the most prescribed biologic (34 patients), followed by Etanercept (25 patients), Adalimumab (6 patients), Anakinra (3 patients) and biosimilar Infliximab (3 patients). Eleven patients switched biologics. Erythrocyte sedimentation rate, number of active joints and the Juvenile Arthritis Disease Activity Score 27 (JADAS 27) decreased significantly at month three for 56 patients. These results were maintained at the last visit for 31 patients, while there was a slight worsening in 15 of them and no assessment in 13 patients due to lack of data. At the end of the evaluation, 39% of the patients were exclusively on biotherapy, while 61% were still on other disease-modifying antirheumatic drugs (DMARDs). Twenty-eight patients developed lymphopenia, 4 patients had elevated transaminases, 4 patients developed moderate infection, and 2 patients developed macrophage activation syndrome. To the best of our knowledge, this is the first Moroccan study on biotherapy in JIA. Our study population was characterized by a male predominance, a high frequency of the systemic form and a low percentage of positive antinuclear antibodies. We have shown that in the era of biologics, only 67.4% patients are nearly disease-free at the end of the study with a real risk of side effects. Although effective, biotherapy must be closely monitored because of potentially severe side effects, especially with Tocilizumab use.
在这项研究中，我们旨在评估摩洛哥幼年特发性关节炎（JIA）患者的临床生物学发现和生物治疗反应，并将我们的结果与同种族或不同种族的人群进行比较。这项回顾性横断面研究纳入了 2003 年至 2018 年间根据国际风湿病联盟（ILAR）2004 年修订标准诊断为 JIA 的年龄在 1-14 岁的患者，这些患者接受了生物治疗，并在我们单中心三级儿科风湿病科的日间病房接受了 2018 年的随访。在 59 名患者中，53%为全身型 JIA，29%为血清阴性多关节炎型 JIA，8%为关节炎相关附着点炎，5%为血清阳性多关节炎型 JIA，3%为少关节炎型 JIA，2%为银屑病关节炎型 JIA。最常开的生物制剂是托珠单抗（34 例），其次是依那西普（25 例）、阿达木单抗（6 例）、阿那白滞素（3 例）和生物类似物英夫利昔单抗（3 例）。11 名患者更换了生物制剂。56 名患者在第 3 个月时红细胞沉降率、活跃关节数和幼年特发性关节炎疾病活动评分 27（JADAS 27）显著下降。在最后一次就诊时，31 名患者的这些结果得到了维持，而在其中 15 名患者中略有恶化，13 名患者由于缺乏数据而无法评估。在评估结束时，39%的患者仅接受生物治疗，61%的患者仍在接受其他疾病修饰抗风湿药物（DMARDs）治疗。28 名患者出现淋巴细胞减少症，4 名患者出现转氨酶升高，4 名患者出现中度感染，2 名患者出现巨噬细胞活化综合征。据我们所知，这是摩洛哥首例关于 JIA 生物治疗的研究。我们的研究人群以男性为主，全身型发病率高，抗核抗体阳性率低。我们已经表明，在生物制剂时代，只有 67.4%的患者在研究结束时接近无疾病状态，但存在潜在的副作用风险。尽管有效，但由于潜在的严重副作用，生物治疗必须密切监测，特别是在使用托珠单抗时。
