Home

Current Issue

Archives

Guidelines for Authors

Classified Ads

Links

Search PubMed

Subscriptions

Subscriber Registration

Guidelines for Website Users

JRheum Update Service

Contact Info

MICHAEL HENRICKSON and ANDREAS REIFF

ABSTRACT.

Objective. For many children enthesitis-related arthritis (ERA) causes substantial morbidity, and conventional treatments frequently offer limited efficacy. Tumor necrosis factor-a (TNF-a) has been found to play a central role in the spondyloarthritides. We investigated the longterm efficacy of the TNF fusion protein etanercept in the treatment of patients with ERA refractory to disease modifying antirheumatic drug (DMARD) therapy.

Methods. Eight patients with active, inflammatory ERA were treated in an open-label pilot trial of twice weekly subcutaneous injections (dosing range of 25 to 37.5 mg twice weekly, 0.2–0.8 mg/kg/dose) of etanercept for 2 years. Outcome measures included duration of morning stiffness, active joint count, hemoglobin, and erythrocyte sedimentation rate (ESR). Patients were permitted concomitant nonsteroidal antiinflammatory drugs (NSAID) and DMARD at stable doses.

Results. Treatment with etanercept resulted in significant improvement in active joint count, hemoglobin, and ESR in all 8 patients within 2 months. Additionally, all patients noted increased mobility and overall well being. Improvement in morning stiffness did not achieve statistical significance. One patient was lost to followup after completing one year of the study. The remaining 7 patients had sustained statistically significant efficacy for active joint count, hemoglobin, and ESR throughout the entire 2-year trial. All patients tolerated etanercept with no side effects.

Conclusion. Despite limited power, these results indicate that etanercept provided a rapid clinical response in our cohort of patients with refractory ERA, who achieved sustained efficacy over a 2-year period. (J Rheumatol 2004;31:2055-61)

Key Indexing Terms:

ENTHESITIS-RELATED ARTHRITIS
JUVENILE ANKYLOSING SPONDYLITIS
ETANERCEPT

M. Henrickson, MD, Assistant (Clinical) Professor of Pediatrics, University of California, San Francisco School of Medicine, Fresno Medical Education Program; A. Reiff, MD, Associate Professor of Pediatrics, Keck School of Medicine, University of Southern California.

Address reprint requests to Dr. M. Henrickson, Room G270, Division of Rheumatology, Children's Hospital Central California, 9300 Valley Children's Place, Madera, CA 93638-8762. E-mail: mhenrickson@childrenscentralcal.org

Submitted June 18, 2003; revision accepted April 23, 2004.