Anti TNF a therapy effective for juvenile spondylarthropathy

Anti-TNF a therapy is reported to be effective for refractory juvenile spondylarthropathy (SpA), according to a recent preliminary investigation.To examine the impact of anti-TNF a agents on juvenile SpA refractory to nonsteroidal antiinflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs, and corticosteroids, Dr Shirley Tse and colleague enrolled ten children.The children were of a mean age of 15 years and disease duration of 4.4 years. All participants were HLA-B27 positive and followed up for one year after initiation of either infliximab (n=8) or etanercept (n=2).The authors report that by six months, arthritis and enthesitis significantly improved in all patients. This was demonstrated by remission of the tender entheseal count (TEC) and active joint count (AJC). These improvements were sustained during the one-year follow-up.Also, markers of inflammation and Health Assessment Questionnaire scores normalised and there was a reduction in requirements for antirheumatic drugs (reduced dosage or discontinuation of NSAIDs (n=10), methotrexate (n=5), sulfasalazine (n=6), corticosteroids (n=4), and bisphosphonates (n=1)."Standard anti-rheumatic therapy for juvenile SpA may be ineffective in preventing disease progression leading to significant disability and reduced quality of life," Dr Tse comments, adding "Our study demonstrates rapid and sustained improvements to the arthritis and enthesitis as well as laboratory markers of inflammation in response to anti-TNF alpha agents."In concluding the team propose anti-TNF a therapy as a potential novel treatment for refractory juvenile SpA and call for further investigation.Reference...