Abstract
TNF-alpha-blocking agents (anti-TNF) used in juvenile idiopathic arthritis (JIA) are well established; however, time to withdraw is unclear. Neither prolonged nor tapering treatment seems to influence risk of relapse. Our aim was to assess relapse percentage after anti-TNF withdrawal of our non-systemic JIA patients after reaching clinical remission. A retrospective review of our non-systemic JIA patients in whom anti-TNF had been withdrawn due to inactive disease was achieved, between December 2000 and November 2011. We analyzed percentages of relapse according to JIA categories and antinuclear antibodies (ANA) positivity. n = 18 patients were included. Eighty-two percentage of patients relapsed after treatment withdrawal, and mean time to relapse was 3.04 months (SD 2.03). The percentage of relapse after anti-TNF discontinuation in the main JIA category was 88 % of negative rheumatoid factor polyarticular JIA and 80 % of persistent oligoarticular JIA. We did not find significant statistical differences according to ANA positivity (9 of 14 were ANA positive), and mean time to relapse (days) was 85.0 (SD 69.4) for ANA-positive versus 102.4 (SD 47.7) for ANA-negative patients (p = NS). Relapse percentage following anti-TNF discontinuation was high (82 %) and occurred within the first 3 months after it. No relationship regarding JIA subtype and ANA positivity was found.
References
Beukelman T, Patkar NM, Saag KG et al (2011) 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthr Care Res 63(4):465–482
Prince FHM, Twilt M, Simon SCM et al (2009) When and how to stop etanercept after successful treatment of patients with juvenile idiopathic arthritis. Ann Rheum Dis 68(7):1228–1229
Pratsidou-Gertsi P, Trachana M, Pardalos G et al (2010) A follow-up study of patients with juvenile idiopathic arthritis who discontinued etanercept due to disease remission. Clin Exp Rheumatol 28(6):919–922
Remesal A, De Inocencio J, Merino R et al (2010) Discontinuation of etanercept after successful treatment in patients with juvenile idiopathic arthritis. J Rheumatol 37(9):1970–1971
Baszis K, Garbutt J, Toib D et al (2011) Clinical outcomes after withdrawal of anti-tumor necrosis factor α therapy in patients with juvenile idiopathic arthritis: a twelve-year experience. Arthr Rheum 63(10):3163–3168
Postepski J, Kobusinska K, Olesinska E et al (2012) Clinical remission in juvenile idiopathic arthritis after termination of etanercept. Rheumatol Int 21 Jul [Epub ahead of print]
Petty RE, Southwood TR, Manners P et al (2004) International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31(2):390–392
Wallace CA, Ruperto N, Giannini E (2004) Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. J Rheumatol 31(11):2290–2294
Ravelli A, Varnier GC, Oliveira S et al (2011) Antinuclear antibody-positive patients should be grouped as a separate category in the classification of juvenile idiopathic arthritis. Arthr Rheum 63(1):267–275
Ravelli A, Felici E, Magni-Manzoni S (2005) Patients with antinuclear antibody-positive juvenile idiopathic arthritis constitute a homogeneous subgroup irrespective of the course of joint disease. Arthr Rheum 52(3):826–832
Felici E, Novarini C, Magni-Manzoni S et al (2005) Course of joint disease in patients with antinuclear antibody-positive juvenile idiopathic arthritis. J Rheumatol 32(9):1805–1810
Conflict of interest
The authors declare that they do not have any conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Iglesias, E., Torrente-Segarra, V., Bou, R. et al. Non-systemic juvenile idiopathic arthritis outcome after reaching clinical remission with anti-TNF-α therapy: a clinical practice observational study of patients who discontinued treatment. Rheumatol Int 34, 1053–1057 (2014). https://doi.org/10.1007/s00296-013-2884-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-013-2884-z