Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Effectiveness of Etanercept in Juvenile Psoriatic Arthritis and in Children with Enthesitis Related Arthritis.

Otten3,  Marieke H., Prince4,  Femke H. M., Twilt7,  Marinka, Wulffraat12,  Nico M., Cate7,  Rebecca ten, Hoppenreijs9,  Esther P. A. H., Koopman-Keemink6,  Yvonne

Academic Medical Centre Emma Children's Hospital and Jan van Breemen Institute Amsterdam
University Hospital Maastricht
University Medical Centre Groningen Beatrix Children's Hospital
Utrecht Medical Centre Wilhelmina Children's Hospital
VU Medical Centre and Jan van Breemen Institute Amsterdam
Erasmus MC Rotterdam
Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
Erasmus MC Sophia Children's Hospital Rotterdam
Erasmus MC Sophia Children's Hospital Rotterdam, The Netherlands
Haga Ziekenhuis Juliana Children's Hospital The Hague
Leiden University Medical Centre
St Lucas Andreas Hospital and Jan van Breemen Institute Amsterdam
St Maartenskliniek Nijmegen

Background:

Etanercept (ETN) has proven to be effective in children with systemic and polyarticular Juvenile Idiopathic Arthritis (JIA). Experience with ETN in the treatment of Juvenile Psoriatic Arthritis (JPsA) and Enthesitis Related Arthritis (ERA) subtypes is limited. We therefore explored the effectiveness of ETN in these subtypes.

Methods:

This study is embedded in the ABC-register, a since 1999 prospective ongoing multicentre, observational study of all Dutch JIA patients using biological agents. Patient and disease characteristics are collected at baseline. At start of treatment, after 3, 6, 15 months and thereafter yearly variables of the JIA disease activity score; physician's global (VAS), Childhood Health Assessment Questionnaire (CHAQ), including global assessment of wellbeing (VAS), number of active and limited joints and ESR, are retrieved. Response was assessed by the ACR pediatric criteria, and Wallace criteria for inactive disease. We collected additional data regarding the diagnostic ILAR criteria for JPsA and ERA.

Results:

Our register includes 17 JPsA and 14 ERA patients treated with ETN.

JPsA patient characteristics: 71% female, median age at onset 11.0 (range 3.3–13.3) years, 47% with psoriatic skin lesions, 41% nail psoriasis, and 24% dactylitis. Median follow-up since start etanercept of 26 (range 3–62) months.

ERA patient characteristics: 79% male, median age at onset 10.4 (range 2.3–17.0) years, presence of enthesitis in 86%, SI-joint tenderness and/or inflammatory lumbosacral pain in 57%, and HLA-B27 positivity in 79%. Median follow-up since start etanercept of 46 (range 6–110) months.

After 3 months of treatment 82% of JPsA and 86% of ERA patients achieved ACRpedi30 response, increasing after 15 months to 100% and 91% resp. Of the JPsA patients reaching 39 months of follow-up (n=6) 67% achieved inactive disease and of the ERA patients (n=4) 50% (Figure 1).

In only 4 of the 8 patients with pre-existing psoriasis the skin lesions improved. Two JPsA patients and 2 additional JIA patients with other subtypes from our register developed de novo psoriasis during ETN treatment.

In both subtypes there was no ETN discontinuation because of inefficacy. Six JPsA patients and 1 ERA patient discontinued treatment after good clinical response. However, all except 1 JPsA patient flared again. They all restarted treatment with good clinical response.

Conclusion:

We showed that ETN is very effective to treat the arthritis in the JPsA and ERA subtypes, with more than 90% achieving ACRpedi30 response after 15 months of treatment. However the psoriatic skin lesions did not respond very well and de novo psoriatic skin lesions occurred in JPsA patients and in patients with other JIA subtypes during ETN treatment. In most patients the arthritis flared after discontinuation of treatment, emphasizing the need to investigate optimal duration of therapy.

Figure 1. Improvement and inactive disease based on an intention-to-treat modus. Shown are percentages of JPsA and ERA patients that met the criteria for the ACR Pedi 30, 50 and 70 and inactive disease compared to all JIA subtypes and all non-systemic JIA subtypes (i.e. subtypes other than systemic JIA), as published from our register in 2009.

To cite this abstract, please use the following information:
Otten, Marieke H., Prince, Femke H. M., Twilt, Marinka, Wulffraat, Nico M., Cate, Rebecca ten, Hoppenreijs, Esther P. A. H., et al; Effectiveness of Etanercept in Juvenile Psoriatic Arthritis and in Children with Enthesitis Related Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :219
DOI: 10.1002/art.27988

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