Clinical remission in patients with systemic juvenile idiopathic arthritis treated with anti-tumor necrosis factor agents

Systemic JIA: new developments in the understanding of the pathophysiology and therapy

Systemic juvenile idiopathic arthritis (sJIA) is a rare, systemic inflammatory disease classified as a subtype of JIA. Besides arthritis, it is characterised by systemic features such as spiking fever, skin rash, hepatosplenomegaly or serositis. It is becoming clear now that abnormalities in the innate immunity (cytokines such as interleukin (IL)-1, IL-6 and IL-18, and neutrophils and monocytes/macrophages rather than lymphocytes) play a major role in the pathogenesis of sJIA, distinguishing it from other JIA subtypes. Another distinctive feature of sJIA is its strong association with macrophage activation syndrome (MAS). Based on this, consensus is emerging that sJIA should be viewed as an autoinflammatory syndrome rather than a classic auto-immune disease. As a consequence of the progression in understanding the underlying mechanisms of sJIA, major changes in the management are evolving. So far, treatment has been based on glucocorticosteroids in combination with disease-modifying drugs such as methotrexate. Recently, remarkable improvement has been observed with IL-1 and IL-6 targeted therapies. These therapies might also change the long-term outcome of this disease. However, controlled trials set up in international collaboration are needed to determine the optimal treatment strategies for all sJIA patients.

[Effectiveness and safety of biological therapy with adalimumab]

Adalimumab is a human, recombinant antibody, which is effective in patients with rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, psoriasis, arthritis psoriatica, spondylitis ankylopoetica, as well as with Crohn-disease. Adalimumab has got a high affinity binding to tumor necrosis factor (TNF-alfa), this way it inhibits the interactions with TNF and its receptors (soluble and membrane associated). It is well tolerated and safe, it improves the the quality of life. Possible side effects can be decreased by the careful observation and usual control of patients. The authors discuss in detail the publications on adalimumab in the above mentioned diseases.