Clinical Observation Of Etanercept In Treatment Of Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (juvenile idiopathic arthritis, JIA) is the mostcommon rheumatic diseases of childhood. Studies have shown that about25%-70%of the JIA patients are still in disease activity in10years after the onsetof status. And the disease has become one of the main causes of disability inchildren. At present, JIA treatment is mainly to control the fever and joint symptomsof acute phase, to maintain growth and reduce disability. There are still no specifictherapies. With the development of research on the role of the immune system in thepathogenesis of JIA and the study of biological agents, the treatment of JIAcomes into a new era. Researches show that tumor necrosis factor alpha (TNF-α) andinterleukin1β (IL-1β) plays a very important role in the immune pathogenesis andthe inflammatory process of JIA. TNF-α antagonist can reduce inflammation andjoint destruction.Recombinant human tumor necrosis factor receptor-antibody fusion protein(rhTNFR:Fc, Etanercept) is a kind of fusion protein produced by using generecombination technology. It can specifically block the TNF-α interaction with cellsurface receptors to achieve the purpose of treating rheumatic diseases. In foreigncountries, Etanercept has been applied to the treatment of JIA and obtained a goodcurative effect. In the domestic, Etanercept is gradually applied to the early treatmentof JIA. Thus Etanercept used in treatment of juvenile idiopathic arthritis has somepractical significance.Objective: children with JIA has long course of disease, which has greatinfluence on the growth and development and living quality in children. If delaytreatment, they can cause joint deformity and loss of joint function, serious threatsto the health of children. The purpose of this study is to explore the effective scheme of JIA early treatment by early curative effect observation of Etanercept on childrenwith JIA and analysis of some influential factors such as age, gender and clinicaltyping, so as to relieve the pain of children with JIA, delay joint deformity andinduce the remission in the clinic.Methods: Information of66outpatients and inpatients with juvenile idiopathicarthritis were collected in our hospital from2009to2012in a grade iii-A hospital ofChangchun in Changchun. Their diagnosis was conformed to the rheumatologydiagnostic criteria of ILAR set by2001. They were divided into two groups,34casesas control group (group A) and32cases as treatment group (group B). Beforetreatment in de two groups were comparability.The patients of control group were thepeople used with non steroidal anti-inflammatory drugs and methotrexate.Methotrexate was intravenous7.5mg/m2per week, for12weeks in a raw. The patientsof treatment group were the people used with non steroidal anti-inflammatory drugs,Methotrexate and Etanercept. Usage and dosage of non steroidal anti-inflammatorydrugs and Methotrexate was the same as control group. Etanercept was hypodermic0.4mg/kg per time and2times per week for12weeks in a raw. The level of eachpatient’s ACR Pedi30、ACR Pedi50、ACR Pedi70and their adverse drug reactionswere recorded and analysed before treatment,2weeks after treatment,1months aftertreatment and3months after treatment. The ACR Pedi30,50,70scoringmethod including5indicators, including the overall evaluation of physicians topatients, the overall evaluation of patients or their parents on patient’s condition,Active inflammatory joints counting, activity limitation joints counting, determinationof erythrocyte sedimentation rate assessment (ESR). The definition of improvedtreatments is as follows:3or more components of five have more than30%improvement were known as ACR Pedi30improvement; if the3or morecomponents of five has more than50%or70%improvement were known asthe ACR Pedi50or70improvement. The percentage of indicator improvement (%)=(value before treatment-value after treatment)/value before treatment x100%.Besides, the adverse drug reactions need to record down. Results: In the treatment group,37.5%patients achieved ACR Pedi30after2weeks treatment, and68.6%children patients achieved ACR Pedi30after1monthtreatment, and after3months treatment,81.3%patients achieved ACR Pedi30, and71.9%patients achieved ACR Pedi50, and50%patients achieved ACR Pedi70. Theresults showed that it had significant difference compared with control group, withstatistical significance (P<0.05). The treatment effect of treatment group’s patients indifferent age and different gender was analysed and had no significant difference,without statistical significance (P>0.05). The results suggest that the factors of ageand gender did not affect the efficacy of Etanercept in the treatment of JIA. Thetreatment effect of treatment group’s patients in clinical typing was analysed andsystemic JIA, oligoarticular JIA and multi-joint type JIA had different ACR30、ACR50and ACR70after3months treatment. It had significant difference, withstatistical significance (P <0.05). Curative effect of Etanercept on treatment of JIAwas different in clinical types. All the patients had no obvious adverse reactions aftertreatment of12weeks. Before and after the treatment, the level of white bloodcells, liver function and renal function appeared to be normal.During treatment, itoccurred in5patients with upper respiratory tract infection including fever, sorethroat and runny nose. The infection symptoms disappeared after3days treatment ofanti-infection and symptomatic treatment. The infection symptoms have no impact onthis study. The adverse reaction rate is lower than the foreign reported rate of18.37%-21.0%. The patients had no secondary tuberculosis, tumor, systemic lupuserythematosus, death and other serious adverse reactions occurred.Conclusions: In this study, the curative effect of Etanercept in treatment ofchildren with JIA from2009to2012in a grade iii-A hospital of Changchun isanalyzed. The results showed that Etanercept was fast onset. It could improvejoint function of children with JIA and had a certain clinical relief. Moreover, thedifferent age and different gender of children with JIA had no influence onthe Etanercept therapy effect. But the different clinical typing of JIA could influenceon the Etanercept therapy effect. It had significant therapy effect of Etanercept on oligoarticular JIA and multi-joint type JIA were but had bad therapy effect onsystermic JIA Etanercept’s application on JIA treatment in a short term rarelyhas adverse reactions. It can be used for early treatment of JIA, especiallyoligoarticular JIA and multi-joint type JIA.