Treatment of systemic juvenile idiopathic arthritis

Oxygen-supplying nanotherapeutics for bacterial septic arthritis via hypoxia-relief-enhanced antimicrobial and anti-inflammatory phototherapy

Bacterial septic arthritis, an inflammatory disease caused by bacterial infections, is often accompanied by the emergence of multidrug-resistant bacteria, making therapeutic treatment a formidable challenge. With the emergence of antibiotic resistance, research on antimicrobial photodynamic therapy (aPDT) has regained attention. However, insufficient singlet oxygen production due to the hypoxia in the infection microenvironment is recognized as a key limiting the efficacy of aPDT. Hence, in this study, we designed a bacteria-targeted liposomal nanoplatform (MCPL) to alleviate hypoxia in the infectious microenvironment and enhance aPDT for bacterial septic arthritis. The nanoplatform was developed by integrating the phototherapeutic agent CyI and small-sized Pt NPs into thermosensitive liposomes, with modification of maltohexose on the liposome surface. In vitro and in vivo studies showed that MCPL could specifically target bacterial cell membranes and be thermally activated to catalytically convert endogenous hydrogen peroxide (H2O2) in the septic joint, supplementing local O2 reservoirs. This, in turn, supplies additional substrate pools for photodynamic conversion into reactive oxygen species (ROS) with bacterial toxicity. Furthermore, the antibacterial mechanism revealed that MCPL can regulate the HIF-1α and NF-κB signaling pathways in immune cells, acting as an effective modulator of antioxidant and anti-inflammatory pathways in both macrophages and neutrophils. This study demonstrates that MCPL could not induce bacterial multidrug resistance and provide as an innovative approach for treating bacterial septic arthritis.

Latent class analysis identifies distinct pain phenotypes in newly diagnosed systemic juvenile idiopathic arthritis

BACKGROUND

Patients with systemic juvenile idiopathic arthritis (sJIA) exhibit highly heterogeneous pain manifestations, which significantly impact their quality of life and disease prognosis. An understanding of the pain phenotypes for this disorder and their influencing factors is crucial for individualized pain management.

OBJECTIVE

To explore the pain phenotypes of newly diagnosed sJIA patients via latent class analysis (LCA), analyse the influencing factors of these phenotypes, and evaluate the impacts of different pain phenotypes on short-term inpatient outcomes.

METHODS

A retrospective cohort study was conducted by collecting the electronic health records of 165 patients who were first diagnosed with sJIA at the Children's Hospital of Chongqing Medical University from January 2018 to July 2024. Patient pain characteristics, laboratory indicators, and inpatient outcome data were extracted. LCA was used to identify pain phenotypes, and multivariate logistic regression was used to analyse the influencing factors. The Lanza-Tan-Bray method and the data combination analysis technique were applied to evaluate the relationships between pain phenotypes and clinical outcomes.

RESULTS

LCA categorized the pain phenotypes of sJIA patients into three distinct classes, including (1) Class 1: inflammation-related moderate to severe pain with functional impairment (53.9% of patients); (2) Class 2: mild intermittent pain with extra-articular symptoms (19.4% of patients); and (3) Class 3: no joint pain with mild functional impairment (26.7% of patients). The analysis revealed that age (P = 0.023) and serum IL-10 levels (P = 0.047) were significant factors influencing pain phenotypes. Significant differences were observed among different pain phenotypes in terms of hospital stay duration, intrahospital department transfer rates, and pain status at discharge.

CONCLUSION

Pain in sJIA patients can be classified into three distinct phenotypes, which are influenced by factors such as age and IL-10 levels. The identification of these pain phenotypes has important clinical significance for developing individualized pain management strategies.

Comparative efficacy and safety of etanercept and adalimumab in the treatment of polyarticular juvenile idiopathic arthritis

OBJECTIVE

This study aims to evaluate the efficacy and safety of Etanercept and Adalimumab in the treatment of polyarticular juvenile idiopathic arthritis (pJIA).

METHODS

From Jan 2021 to Oct 2023, 66 pJIA patients were prospectively randomized into Etanercept (n = 33) and Adalimumab (n = 33) groups at our hospital. Efficacy, via Juvenile Arthritis Disease Activity Score 10 (JADAS-10), and anti-cyclic citrullinated peptide (CCP), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC) were assessed pre-treatment and at 1-, 3-, 6-month intervals post-treatment. Adverse reactions were monitored.

RESULTS

Two groups showed comparable efficacy (P > 0.05) at baseline in anti-CCP, TNF-α, CRP, ESR, WBC, and JADAS-10 score. Treatment for a period of 1 to 3 months led to statistically significant reductions in these markers over time (P < 0.05). Adalimumab group was found significantly lower levels of mentioned markers than Etanercept group at 1-3 months (P < 0.05), but after 6 months, statistical differences vanished (P > 0.05). Normal total bilirubin, alanine transaminase, aspartate aminotransferase, serum creatinine levels were detected post-3 months in both groups; with similar adverse reaction rates (P > 0.05).

CONCLUSION

Both Etanercept and Adalimumab are effective and safe for managing pJIA, demonstrating significant reductions in inflammatory markers and disease activity with no significant difference in efficacy or safety profiles.

CLINICAL TRIAL NUMBER

Not applicable.

Lifetime clinical presentation of Still's disease in the Afro-descendant population of the French West Indies

INTRODUCTION

The continuum in Still's disease has never been addressed in Afro-descendant (AD) populations. The aim of this study was to compare the features of Still's disease between children and adults in the AD population of French West Indies (FWI).

METHODS

Retrospective longitudinal study from January 2000-2022. We included children and adults with systemic juvenile idiopathic arthritis and Still's disease. Clinical data were obtained from computerized hospital archives, registries of clinicians and the national registry for rare diseases. The main outcome was similarity in cardinal and non-cardinal symptoms.

RESULTS

Fifty-eight patients were included (57% adults). Sex distribution between children and adults was significantly different (Female respectively 36% vs 70.6%, P=0.03). Diagnostic criteria overlapped in most cases (80%), regardless of age. The children had significantly more typical skin rashes (100% vs 29.4%, P<0.001), coronary artery dilation (16% vs 0%, P=0.03), and macrophage activation syndrome (52% vs 9%, P<0.001). The adults had significantly more inflammatory polyarthalgia without arthritis (91% vs 32% P<0.001) and pulmonary involvement (51.5% vs 4% P<0.001). The phenotypes were 86% systemic (43% monophasic, 43% polycyclic) and 14% chronic polyarticular. No difference was found in the number of relapses, use of biologics and mortality.

CONCLUSIONS

There is a rationale for considering Still's disease as a single entity in our AD population, focusing on the cardinal symptoms, but particular attention should be paid to the non-cardinal symptoms depending on the age of onset.

Tofacitinib treatment of systemic juvenile idiopathic arthritis: a case report and literature review

Objective

Systemic juvenile idiopathic arthritis (sJIA), a particularly aggressive form of childhood arthritis, is characterized by persistent systemic inflammation. The most advanced treatments include biologic agents that target the interleukin-1(IL-1) and interleukin-6(IL-6) pathways. However, sJIA continue to pose challenging challenges for rheumatologists treating pediatric patients worldwide.

Methods

1 children with sJIA was retrospectively collected from the Department of Rheumatology and immunology, Children's Hospital of Nanjing Medical University, Nanjing. Literature published between 2019 and 2024 was reviewed to understand the effect of tofacitinib on patients with sJIA.

Results

After a month of treatment of tofacitinib, there was a significant improvement in clinical symptoms and inflammatory indicators showed a marked decrease. As of July 2023, the patient's condition was effectively in remission. The efficacy of tofacitinib treatment was remarkable.

Conclusion

Tofacitinib has shown good efficacy and safety in the treatment of sJIA patients, effectively controlling disease activity and relieving symptoms. The application of Janus kinase (JAK) inhibitors may offer a new treatment option for this disease.

Blood molecular subtypes to guide precision treatment strategies in systemic juvenile idiopathic arthritis

BACKGROUND

Systemic juvenile idiopathic arthritis (sJIA) is the most severe subtype of JIA, with a combination of diverse clinical manifestations and a variable clinical course. A comprehensive understanding of molecular signatures at the systems level and the discovery of molecular subtypes are the initial steps toward personalized medicine in sJIA.

METHODS

A blood transcriptomic dataset was collected from patients with systemic JIA (sJIA) (n = 168), polyarticular JIA (n = 254), oligoarticular JIA (n = 96), enthesitis-related arthritis (n = 40), and healthy controls (n = 220). Gene expression profiles were filtered for differentially expressed genes and unsupervised clustering, gene set enrichment, and network-based centrality analyses. The molecular signatures of three novel sJIA subgroups (designated as C1, C2, and C3) were investigated, focusing on their distinct features and treatment responses.

RESULTS

Neutrophil degranulation and the IL-1 signaling pathway were the shared key processes for the three subgroups. Proinflammatory signals, including TNF, IL-6, TLR, and G-CSF signaling pathways, were identified with variation across the subgroups. C1 was the most inflammatory subset with a high-risk profile for macrophage activation syndrome. The C2 subset had the most activated IL-1 and IL-18 signaling pathways. C2 and C3 have higher levels of interferon-stimulated signatures. In a canakinumab-treated dataset, treatment response was correlated with IL1B expression and NF-κB signaling pathway, and neutrophil activation-associated processes were effectively suppressed in a good responder group. GSK3B and p38 MAPK inhibitors showed a significant counteracting effect on the perturbed gene expression of sJIA.

CONCLUSIONS

Neutrophil activation was the key feature in active sJIA. The three molecular subtype scheme enables the formulation of precision medicine strategies in sJIA.

Advancing personalised precision treatment for Still's disease based on molecular characteristics and disease progression

Still's disease, a systemic autoinflammatory disorder with a classic multigenetic background, is characterised by polyarthritis, high-spiking fever, salmon-like evanescent skin rash, and hyperferritinaemia. Although the exact cause of Still's disease remains unclear, it is believed to be influenced by genetic factors, infections, and immune dysregulation. Current studies indicate that neutrophils and macrophages play crucial roles in the pathogenesis of Still's disease, along with involvement of natural killer cells, T cells, and B cells. Advances in biologic agents have expanded treatment strategies beyond conventional approaches, with cytokine-targeted agents showing promise in the management of Still's disease. Some cytokine-targeting biologic agents can be developed based on clinical manifestations, complications, immune cells, and molecular networks. Emphasis of immunophenotyping for precise clinical subtyping and targeted molecular therapies based on these findings is crucial for optimising treatment outcomes. In this Review, we discuss the latest advancements in the understanding of Still's disease pathogenesis and corresponding therapeutic approaches.

Risk factors for growth retardation in children with juvenile idiopathic arthritis: a case-control study

OBJECTIVE

This study aimed to investigate the role of various factors contributing to growth retardation, including nutritional intake, disease duration, and treatment history, and further identify key risk factors that may influence growth outcomes in patients with juvenile idiopathic arthritis (JIA).

METHODS

Clinical data from 155 JIA children who were treated at our hospital between January 2019 and December 2022 were analyzed. The children were divided into the growth retardation group (n = 40) and the non-growth retardation group (n = 115) based on the height Z-score < -2 SD or not. The two groups were compared based on their baseline characteristics, disease-related factors, dietary habits, lifestyle, and family background. Logistic regression and receiver operating characteristic (ROC) curve analyses were employed to identify and assess the factors associated with growth retardation.

RESULTS

Out of the 155 children, 40 (25.81%) were diagnosed with growth retardation. Children with growth retardation were more likely to have a disease duration ≥ 3 years (72.50% vs. 39.13%, P < 0.001), exercise time < 1 h/per day (68.50% vs. 33.04%, P < 0.001), glucocorticoid use (65.00% vs. 34.78%, P = 0.001), and active disease activity (72.50% vs. 37.39%, P < 0.001). These factors were identified as independent risk factors for growth retardation in multivariate analysis. The area under the curve (AUC) values for these factors ranged from 0.651 to 0.676, indicating moderate predictive accuracy. When considering all these factors together, the combined model demonstrated an AUC value of 0.702, suggesting a high predictive value.

CONCLUSION

The incidence of growth retardation in children with JIA is high, with factors such as disease duration, exercise time, GC treatment, clinic visits, picky eating, and disease activity contributing to its development. While each of these factors demonstrates moderate predictive value individually, their combined consideration significantly improves predictive accuracy.

CLINICAL TRIAL NUMBER

Not applicable.

The Theranostic Genome

Theranostic drugs represent an emerging path to deliver on the promise of precision medicine. However, bottlenecks remain in characterizing theranostic targets, identifying theranostic lead compounds, and tailoring theranostic drugs. To overcome these bottlenecks, we present the Theranostic Genome, the part of the human genome whose expression can be utilized to combine therapeutic and diagnostic applications. Using a deep learning-based hybrid human-AI pipeline that cross-references PubMed, the Gene Expression Omnibus, DisGeNET, The Cancer Genome Atlas and the NIH Molecular Imaging and Contrast Agent Database, we bridge individual genes in human cancers with respective theranostic compounds. Cross-referencing the Theranostic Genome with RNAseq data from over 17'000 human tissues identifies theranostic targets and lead compounds for various human cancers, and allows tailoring targeted theranostics to relevant cancer subpopulations. We expect the Theranostic Genome to facilitate the development of new targeted theranostics to better diagnose, understand, treat, and monitor a variety of human cancers.

Inflammation and Related Signaling Pathways in Acute Myeloid Leukemia

Acute myeloid leukemia (AML) is an aggressive hematologic malignancy, and inflammatory signaling is involved in its pathogenesis. Cytokines exert a robust effect on the progression of AML and affect survival outcomes. The dysregulation in the cytokine network may foster a pro-tumorigenic microenvironment, increasing leukemic cell proliferation, decreasing survival and driving drug resistance. The dominance of pro-inflammatory mediators such as IL-11β, TNF-α and IL-6 over anti-inflammatory mediators such as TGF-β and IL-10 has been implicated in tumor progression. Additionally, inflammatory cytokines have favored certain populations of hematopoietic stem and progenitor cells with mutated clonal hematopoiesis genes. This article summarizes current knowledge about inflammatory cytokines and signaling pathways in AML, their modes of action and the implications for immune tolerance and clonal hematopoiesis, with the aim of finding potential therapeutic interventions to improve clinical outcomes in AML patients.

Evaluating treatment practices and challenges in systemic Juvenile Idiopathic Arthritis: a comprehensive survey analysis

OBJECTIVE

This study aims to assess current diagnostic and management for systemic Juvenile Idiopathic Arthritis (sJIA) among physicians, evaluate the challenges encountered in diagnosis and treatment, and identify the educational needs and professional development engagements of physicians managing sJIA.

METHODS

A nationwide survey was conducted from November 2023 to March 2024 across tertiary and secondary pediatric and general hospitals in China. The survey targeted physicians with at least three years of specialty experience, resulting in 310 valid responses from 25 provinces, autonomous regions, and municipalities. The survey collected data on diagnostic practices, treatment approaches, and professional development related to sJIA. Data collection was facilitated through WeChat, and statistical analysis was performed using descriptive statistics. Ethical approval was obtained from the Ethics Committee of Beijing Children's Hospital, with informed consent provided electronically by participants.

RESULTS

The survey indicated that all physicians encountered suspected or confirmed cases of sJIA, highlighting its prevalence and the diagnostic challenges associated. Regarding diagnostic standards, 53.9% of physicians used the "Consensus on the Diagnosis and Treatment of sJIA and Macrophage Activation Syndrome," 18.1% followed the International League of Associations for Rheumatology (ILAR) standards, and 24.8% adhered to the Pediatric Rheumatology International Trials Organization (PRINTO) standards. In treatment strategies, glucocorticoids and IL-6 receptor monoclonal antibodies were extensively used, with the latter receiving "excellent" and "satisfactory" ratings of 46.5% and 36.1%, respectively, demonstrating high efficacy and acceptance. Main challenges included high treatment costs, complexity of diagnosis, patient compliance issues, and potential long-term side effects of biologics. Additionally, 126 doctors (40.7%) actively participated in more than three academic conferences or systematic learning courses related to sJIA, indicating a strong demand for ongoing education, particularly in new treatment developments and diagnostic skills.

CONCLUSION

The findings emphasize the necessity for standardized diagnosis and customized treatment plans tailored to patient-specific conditions in managing sJIA. Key Points • The survey highlights the prevalence and clinical challenges of sJIA among physicians, emphasizing the importance of vigilant diagnosis, multi-system involvement, and differential diagnosis to improve treatment outcomes and patient quality of life.

Therapeutic Potential of Bee and Wasp Venom in Anti-Arthritic Treatment: A Review

Arthritis has a high global prevalence. During the early ancient human era, bee (Apis) venom therapy was employed in Egypt, Greece, and China to alleviate ailments such as arthritis and neuralgia. In addition, bee venom has long been used as a traditional medicine for immune-related diseases in Korea. Wasp (Vespa) venom is a folk medicine of the Jingpo people in Yunnan, China, and has been widely used to treat rheumatoid arthritis. In spite of this, the underlying mechanisms of bee and wasp venoms for the treatment of arthritis are yet to be fully understood. In recent years, researchers have investigated the potential anti-arthritic properties of bee and wasp venoms. Studies have shown that both bee and wasp venom can improve swelling, pain, and inflammation caused by arthritis. The difference is that bee venom reduces arthritis damage to bone and cartilage by inhibiting the IRAK2/TAK1/NF-κB signaling pathway, NF-κB signaling pathway, and JAK/STAT signaling pathway, as well as decreasing osteoclastogenesis by inhibiting the RANKL/RANK signaling pathway. Wasp venom, on the other hand, regulates synovial cell apoptosis via the Bax/Bcl-2 signaling pathway, inhibits the JAK/STAT signaling pathway to reduce inflammation production, and also ameliorates joint inflammation by regulating redox balance and iron death in synovial cells. This review provides a detailed overview of the various types of arthritis and their current therapeutic approaches; additionally, it comprehensively analyzes the therapeutic properties of bee venom, wasp venom, or venom components used as anti-arthritic drugs and explores their mechanisms of action in anti-arthritic therapy.

Comparative efficacy and safety of different drugs in patients with systemic juvenile idiopathic arthritis: A systematic review and network meta-analysis

BACKGROUND

The goal of this study was to estimate the relative efficacy and safety of different biological agents (infliximab, canakinumab, baricitinib, anakinra, adalimumab, tofacitinib, tocilizumab, and rilonacept) compared with placebo for systemic juvenile idiopathic arthritis (JIA) patients, through a network meta-analysis.

METHODS

Pubmed, Embase, and Cochrane Library were searched from database inception to July 2023 for randomized controlled trials comparing different biological agents (infliximab, canakinumab, baricitinib, anakinra, adalimumab, tofacitinib, tocilizumab, and rilonacept) or placebo directly or indirectly in JIA. Bayesian network meta-analyses were conducted. Data was extracted and analyzed by R with gemtc package. The treatment options were ranked using the surface under the cumulative ranking curve (SUCRA) value.

RESULTS

We identified 10 randomized controlled trials and analyzed 898 participants. Canakinumab (odds ratio 55.0, 95% credible intervals 2.4-67.0) was more effective than the placebo, and the difference was statistically significant. However, there was no statistical significance between other drugs versus placebo in terms of the modified ACRpedi30 (P > .05). The SUCRA shows that canakinumab ranked first (SUCRA, 86.9%), anakinra ranked second (SUCRA, 77.7%), adalimumab ranked third (SUCRA, 61.9%), and placebo ranked the last (SUCRA, 6.3%). Nevertheless, there were no notable discrepancies in the occurrence of adverse events, hepatic-related adverse events, infectious adverse event, serious adverse events, and serious infection following treatment with canakinumab, anakinra, tocilizumab, rilonacept, or the placebo. Based on the clustergram of modified ACRpedi30 and adverse events, canakinumab is suggested for JIA according to the surface under SUCRAs considering the symptom and adverse events simultaneously.

CONCLUSIONS

Among patients with JIA, canakinumab exhibited the highest likelihood of being the optimal treatment for achieving the modified ACRpedi30 response rate, and neither of the tested biological agents carried a significant risk of serious adverse events.

Treatment of non-systemic juvenile idiopathic arthritis

In the past two decades, the treatment of juvenile idiopathic arthritis (JIA) has evolved markedly, owing to the availability of a growing number of novel, potent and relatively safe therapeutic agents and the shift of management strategies towards early achievement of disease remission. However, JIA encompasses a heterogeneous group of diseases that require distinct treatment approaches. Furthermore, some old drugs, such as methotrexate, sulfasalazine and intraarticular glucocorticoids, still maintain an important therapeutic role. In the past 5 years, information on the efficacy and safety of drug therapies for JIA has been further enriched through the accomplishment of several randomized controlled trials of newer biologic and synthetic targeted DMARDs. In addition, a more rational therapeutic approach has been fostered by the promulgation of therapeutic recommendations and guidelines. A multinational collaborative effort has led to the development of the recommendations for the treat-to-target strategy in JIA. There is currently increasing interest in establishing the optimal time and modality for discontinuation of treatment in children with JIA who achieve sustained clinical remission. The aim of this Review is to summarize the current evidence and discuss the therapeutic approaches to the management of non-systemic phenotypes of JIA, including oligoarthritis, polyarthritis, enthesitis-related arthritis and psoriatic arthritis.