Session Type: Abstract Submissions (ACR)
The prevalence of juvenile idiopathic arthritis (JIA) is approximately 3.3/1000 children and 10- 15% have the systemic form (SJIA). Biologics, specifically anti-IL -1 and anti-IL-6 agents have been introduced to decrease the need for corticosteroids and therefore ameliorate the associated morbidity including growth failure, cataracts, fractures and body image problems
Retrospective chart review of 306 patients diagnosed with SJIA at Hospital of sick children from January 1980 to December 2012. Exclusion criteria: Diagnosis not confirmed, <1 year follow-up, <1 visit per year and unable to obtain complete medical record.
1) Number of patients treated with biologics.
2) Response of: i) Systemic features (fever or rash) and ii) Arthritis.
3) Definition of response for systemic features i) Complete response: no symptoms off steroids. ii) Partial response: no symptoms but on steroids.
4) Definition of response for arthritis: i) Complete response: no active arthritis ii) Partial response: >50% improvement in active joint count.
The cohort consisted of 306 SJIA patients which 58 of them (18%) have received biologic. 28/58 (48%) Since 2009. The main biologic used are anti-IL-1 , anti-IL-6 and anti TNF. 41/58 needs one biologic, 10/58 two biologic and 7/58 three or more. Some patients used same biologic more than once. Anti IL-1 was used 47 times in the 58 patients (81%), anti IL-6 used 14 times (24%) and anti TNF used 38 times (65%). The complete response of systemic features was about 70% in both anti IL-1 and anti IL-6 group, however it was 20% in anti TNF group. The complete response of arthritis was 64%, 48% and 31% in anti IL-6, anti IL-1 and anti TNF respectively.
SUMMARY: 1) 58/306 received biologic during the study- 28/58 (48%) since 2009. 2)The main biologics used were: anti-IL-1, anti-IL-6 and anti-TNF agents.3) A complete response of systemic features was found in about 70% for both anti-IL-1 and anti- IL-6 groups but only 20% in the anti-TNF group. 4)A complete response of arthritis was seen in 64%, 48% and 31% in the anti-IL-6, anti-IL-1 and anti-TNF groups respectively
1) Since 2009 there was a significant increase in the use of biologic therapies in SJIA. 2) Systemic features responded well to anti- IL-1 and anti- IL-6 but not anti-TNF treatment.3) Arthritis improved by >66% with anti-IL-1 and anti-IL-6 in all patients but not with anti-TNF treatment.4) Further studies with large number of patients are needed to evaluate anti-IL-1 and anti-IL-6. 5) With anti-IL-1 and anti-IL-6 agents, a substantial proportion of patients were able to discontinue steroid.
B. Al adba,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/biologic-treatment-in-systemic-juvenile-idiopathic-arthritis-single-center-experience/