Efficacy Observation And Long-term Management Of Tocilizumab In The Treatment Of Systemic Juvenile Idiopathic Arthritis

Objective:To investigate the long-term efficacy,safety and adverse effects of Tocilizumab(TCZ)injection in the treatment of systemic juvenile idiopathic arthritis(sJIA),and to evaluate psychological status of all patients with sJJA before and after treatment.Methods:Since October 2016 to October 2019,65 children with sJIA,who were admitted in children’s hospital affiliated Xi’an Jiaotong University,were randomly divided into experimental group(27 cases)and control group(38 cases).Both of two groups,all patients with sJIA were treated by combination of medications.27 patients were administrated TCZ in experimental group,as well nonsteroidal antiinflammatorydrugs(NSAIDs)and Disease-modifying anti-rheumatic drugs(DMARDs).While,38 patients were administrated glucocorticoid(GC),NSAIDs,and DMARDs in control group.We elected some inflammatory indicators at different point in time in order to comprehensively evaluate the efficacy and safety of TCZ.Patients both two groups were compared to indicators such as white blood cell,C-reactive protein,ESR,ferritin,IL-6,the number of joint swelling and pain,disease activity(DAS28 score)and adverse drug reactions(ADRs)before and after combined treatment at the third month,sixth month,ninth month,1 year,1.5 and 2 years.In addition,their psychological status of all patients were evaluated by screening table of anxiety disorders in children(SCARED)and Depression Self-rating Scale for Children(DSRSC).Results:(1)Efficacy:The level of inflammatory factors were significantly higher than normal before treatment in two groups,and there was no statistical difference(P>0.05).At three months after combined treatment,the symptoms of patient were remarkably improved in two groups,and the indicators such as joint pain index,ESR,CRP and FER were rapidly decreased in experimental group than that in control group(P < 0.05).Moreover,comparing indicators at six month,12 month,and 24 month after combined treatment in two groups,we found that the level of inflammatory factors(CRP,ESR,FER)could persist to keeping low level in experimental group,but the inflammatory factors and joint pain were more tend to recurrent in control group.There were statistical significance about DAS 28 scores in two groups.(2)Psychological evaluation: The values of anxiety and depression were normal before combined treatment in two groups.After treatment,thescores of anxiety and depression were lower in experimental group than those in control group,but there were no statistical difference(P>0.05).The scores of SCARED of 3children were more than 23 in control group,which indicated they maybe suffer from anxiety disorder.(3)Adverse reactions: There were 3 cases of repeated upper respiratory tract infection,2 cases of increased liver function transaminase,2 cases of decreased neutrophils in the experimental group,and all above adverse reactions completely improved after treatment,and there were no serious and special adverse effects in follow-up period.The main adverse reactions were Cushing appearance,growth retardation,osteoporosis,secondary hypertension and so on in the control group.Conclusion: The treatment of systemic juvenile idiopathic arthritis with TCZ can achieve long-term clinical remission,high safety,less adverse reactions.