Stellenwert der neuen Biologicals und Zytokinantagonisten in der Therapie der juvenilen idiopathischen Arthritis (JIA)

[Anti-TNF-α in the treatment of uveitis in the Besançon Hospital]

BACKGROUND

Noninfectious chronic uveitis is a difficult-to-treat situation in which corticosteroids, immunosuppressive agents, and more recently, anti-tumor necrosis factor (TNF)-α are used to prevent and/or reverse severe visual impairment. This single-center retrospective study was designed to assess the use (indications, efficacy, and side effects) of anti-TNF-α agents in noninfectious uveitis.

PATIENTS AND METHODS

Eight patients were analyzed: three children (age, 7-15 years) and five adults (age, 27-44 years). Anti-TNF-α agents were etanercept (three patients), adalimumab (four patients), and infliximab (four patients). Diagnoses were Behçet's diseases (n=3), sarcoidosis (n=1), juvenile chronic arthritis (n=2), spondyloarthropathy (n=2), one of the latter two combined with Crohn disease. In all cases, anti-TNF-α therapies were prescribed because uveitis and/or associated disease were not under control.

RESULTS

Adalimumab and infliximab were effective for all patients. One patient with infliximab needed to add corticosteroids and immunosuppressive agents because of relapse. Etanercept was stopped in all cases due to a lack of effectiveness or a change in indication. In all patients, anti-TNF-α agents improved uveitis and the underlying systemic disease. In children, their use improved quality of life by corticosteroid weaning. Prescriptions did not comply with regulations for three children, because of age limits (etanercept, one; adalimumab, two). No adverse event was recorded.

CONCLUSION

In this short case series, anti-TNF-α agents were effective both on uveitis and the underlying systemic disease and were well tolerated in patients with noninfectious chronic uveitis.

Therapy of psoriasis in childhood and adolescence - a German expert consensus

Psoriasis of childhood shows an annual prevalence of 0.71 % and accordingly has to be regarded as a frequent chronic inflammatory skin disorder of this age. The impact on the quality of life as well as development of the afflicted children and their parents is evident. On the other side, therapy is demanding with regard to the specific juvenile metabolism, physical development and skin penetration of topical drugs. Long-term treatment at an early age has to be critically judged regarding the chronicity of the disease. Topical corticosteroids, alternatively dithranol may be used first-line, followed by vitamin D derivatives. A combination with UV-light, preferably UV-B, has to be decided on an individual basis. Systemic treatment may be initiated in recalcitrant disease with methotrexate and cyclosporine where long-term experience is available from juvenile rheumatology and transplantation medicine. Alternatively fumaric acid esters or retinoids are available. Rehabilitation procedures will help the children and their parents to cope with the disease and its treatment. The different treatment options are presented here as a German expert consensus, as clinical studies are hardly available and only a few therapeutics are licensed for this age. In any case the therapy has to be individually planned and decided together with the patients and their parents to gain maximal safety, comfort and success.

Abatacept: A review of a new biologic agent for refractory rheumatoid arthritis for dermatologists

Abatacept is a newly approved treatment for rheumatoid arthritis refractory to other agents. Abatacept is a fusion protein of the cytotoxic T-lymphocyte antigen (CTLA) molecule and immunoglobulin (Ig) G1 that blocks CD28. Specifically, abatacept blocks the CD80 and CD86 ligands on the surface of antigen-presenting cells that must interface with the T-cell's CD28 receptor to activate T cells. Abatacept seems to be more immunosuppressive than tumor necrosis factor alpha blockers. The combination of abatacept and a tumor necrosis factor alpha blocking agent does not seem more effective than either agent alone. Because abatacept has the ability to suppress T-cell function, it has the potential to be a treatment for psoriasis and other autoimmune conditions involving pathologic processes driven by T cells.

Is there a relationship between juvenile idiopathic arthritis and periodontitis?

AIM

The aim was to compare the prevalence of periodontal conditions in patients with juvenile idiopathic arthritis (JIA) (n=78, age 14.4 years) with those revealed in a healthy control group (n=75, age 15.5 years).

MATERIAL AND METHODS

In both groups, the approximal plaque index (API), the modified sulcular bleeding index (SBI), and the clinical attachment loss (CAL) were determined. Laboratory parameters for JIA activity included the capsule-reactive protein (CRP) and the immunoglobulins A, G, M.

RESULTS

JIA patients had a significantly higher API (64.6%versus 49.9%, p=0.004) and slightly higher mean percentages of sites with CAL>3.5 mm (0.58%versus 0.22%, p=0.041). There was no significant difference in the prevalence of patients and controls who had sites with CAL >3.5 mm (25.6%versus 17.3%, p=0.212). The mean CAL was slightly greater (0.2 mm; p=0.030) in patients with CRP> or =5.0 mg/l compared with patients with CRP<5.0 mg/l. Patients who took non-steroidal anti-inflammatory drugs (NSAIDs) had a significantly decreased SBI (26.2%versus 51.1%, p=0.019).

CONCLUSION

After adjustment for microbial plaque, JIA is not a risk factor for periodontitis.