Etanercept in children with polyarticular juvenile rheumatoid arthritis

Excerpt

Juvenile rheumatoid arthritis (JRA) is a group of diseases, classified as systemic onset, pauciarticular or polyarticular JRA. The latter form can be further divided on the basis of the presence of rheumatoid factor. Polyarticular JRA differs from the adult type with respect to several characteristics such as prevalence, prognosis and response to therapy. In one third of the patients, the disease is controlled with nonsteroidal antiinflammatory drugs and physical and occupational therapy. The remainder are candidates for more aggressive therapy such as sulfasalazine and methotrexate, but some patients do not respond adequately even at doses up to 1 mg methotrexate per kilogram of body weight per week. As in the adult form of arthritis, tumor necrosis factor (TNF) is elevated in serum and synovial fluid of patients with JRA. Serum levels of the soluble TNF-receptor are elevated in these patients and the level correlates with disease activity. The introduction of TNF inhibitors in the treatment of adult patients with RA who did not respond to standard disease-modifying drugs has resulted in a significant clinical benefit with minimal toxicity. This multicenter study evaluated the efficacy and safety of etanercept, a soluble TNF-receptor, in children with polyarticular JRA. …