Clinical remission in juvenile idiopathic arthritis after termination of etanercept.

Biologicals are very effective for inhibiting disease progression in active juvenile idiopathic arthritis (JIA). To date, there have been no recommendations on how and when to stop therapy with TNF inhibitors. Our objective was to analyze characteristics and the disease course of JIA patients who discontinued etanercept due to achievement of inactive disease. Data of 39 patients with JIA from two clinical pediatric rheumatology centers in Bydgoszcz and Lublin (Poland) were analyzed retrospectively. All patients discontinued etanercept due to a remission on treatment. Etanercept was started after a mean 33.7 ± 36 (range 3-137) months of disease. The mean duration of therapy with etanercept was 34.7 ± 16.7 (range 6-72) months, with a mean duration of remission on medication 21.3 ± 9.6 (range 4-42) months before withdrawal of etanercept. The mean duration of remission after etanercept discontinuation was 14.2 ± 12.1 (range of 1-60) months. Only 12/39 (30.8 %) patients did not develop a disease exacerbation until the end of the study. Early flares, that is less than 6 months after termination of etanercept, were observed in 15/39 (38.5 %) patients. Twelve (30.8 %) patients restarted etanercept after exacerbation-all patients responded satisfactorily. Our data show that etanercept discontinuation in a substantial proportion of JIA patients results in early disease exacerbation. In many cases, reintroduction of etanercept is needed. Patients, in whom etanercept was restarted, responded satisfactorily.

Etanercept treatment in juvenile idiopathic arthritis: the Polish registry.

BACKGROUND: To evaluate the long-term safety and efficacy of etanercept treatment in Polish patients with juvenile idiopathic arthritis (JIA). MATERIAL/METHODS: The study involved patients, fulfilling the JIA criteria of the International League of Associations of Rheumatology (ILAR), who were started on etanercept therapy after methotrexate and other synthetic disease-modifying antirheumatic drugs (DMARDs) had proven ineffective. Patient data were collected in an electronic registry. Disease improvement was assessed based on Giannini's criteria. RESULTS: The statistical analysis involved 188 patients. Significant improvement was observed in all clinical and laboratory parameters after the first month of therapy and was maintained in the following months. ACR Pediatric 30, 50, 70, 90, and 100 improvement was observed in 81.4%, 65.9%, 27.5%, 16.2%, and 15%, respectively, of patients after 3 months and in 94.7%, 88.4%, 62.1%, 34.7%, and 26.3%, respectively, after 24 months of treatment. Throughout the 72-month safety observation period, 1162 adverse events were reported; the exposure-adjusted AE rate was 2.96 per patient per year. CONCLUSIONS: In patients with various subtypes of JIA resistant to conventional DMARD treatment, etanercept resulted in significant and long-lasting improvements in disease activity. Combination treatment with etanercept and a DMARD was well tolerated.

[Diagnostics of joint pain in children--controversies]. / Diagnostyka bólów stawów u dzieci--kontrowersje.

Musculoskeletal symptoms can be a manifestation of varied conditions and ailments which are not connected with rheumatic diseases. The aim of the article is to present some controversial elements of differential diagnosis of joint pain in children. Insidious course of the disease can be a cause of diagnostic errors and delays in introducing effective treatment. The article recalls differentiation between rheumatic diseases and neoplastic diseases, osteonecrosis, fibromyalgia and growing pains.

[Rheumatological symptoms masking neoplasm in children]. / Objawy reumatologiczne jako przepowiadajace schorzenia nowotworowe--obserwacje wlasne.

UNLABELLED: Fevers, arthritis, myalgia and skin changes are the most typical features of rheumatic diseases, although one should remember that the same symptoms could mask neoplasm. This study shows that some patients with rheumatological symptoms treated in the Department of Lung Diseases and Children Rheumatology, Medical University of Lublin were finally diagnosed with neoplasm. In focus is the initial phase of the patients' illnesses. MATERIAL AND METHODS: We analyzed retrospectively the case histories of all patients admitted to the department between 1997 and 2005 (1560 hospitalizations). An oncological disease was diagnosed in 9 cases: leukemia in 4 children (acute lymphoblastic leukemia-ALL- in 3 cases, acute non-lymphoblastic leukemia-ANLL- in 1 case), Hodgkin's disease in 1 child, bone tumours in 2 children, liver tumour in 1 child and a tumour of the central nervous system in 1 child. CONCLUSIONS: The cases described should draw the physicians' attention to the fact that in the initial phase an oncological disease may be masked by rheumatological symptoms.

[A case of relapsing polychondritis with severe involvement of the lower airway in 10 years old boy]. / Nawrotowe zapalenie chrzastki z powaznym zajeciem dolnych dróg oddechowych u dziesiecioletniego chlopca.

Relapsing polychondritis is a very rare disease of the connective tissue in children. Inflammation may affect all cartilaginous structures. The study presents the case of a 10 years old boy with bilateral conchitis as a prominent symptom of the disease. In our patient lower airways were seriously affected. The detection of the degree of the disease in respiratory tract was facilitated to a large degree by pulmonary function tests and high resolution computed tomography. Histopathological picture of the inflamed cartilage of the tracheobronchial tree finally confirmed the diagnosis.