New treatment options for children with severe juvenile idiopathic arthritis

New treatment options for children with severe juvenile idiopathic arthritis

According to a study published in the New England Journal of Medicine, juvenile idiopathic arthritis children now benefit from new treatment options. Recent studies conducted by the Paediatric Rheumatology International Trials by Organisation (printout) and the Pediatric Rheumatology Collaborative Study Group (PRCSG)  showed that tocilizumab and canakinumab alleviate symptoms in children with juvenile idiopathic arthritis and reduce the dose of oral corticosteroids.

Juvenile idiopathic arthritis is an inflammatory disease that affects the joints and connective tissues of the various organs: blood vessels, pericardium, peritoneum, pleura, iris etc. The disease occurs in children under 16 years and manifests, besides arthritis, through fever, rash, lymphadenopathy, hepatomegaly, splenomegaly, iridocyclitis, etc.. There are three forms of juvenile idiopathic arthritis: oligoarticular type,  polyarticular type and systemic type. Systemic juvenile idiopathic arthritis (SJIA) represents approximately 15% of cases of juvenile idiopathic arthritis.

juvenile idiopathic arthritis

The treatment of  this disease consists of corticosteroids (prednisone) as it is an inflammatory disease, but this treatment has many side effects. Corticosteroids cause fluid retention, hypertension, glaucoma, peptic ulcer, impaired phosphocalcic metabolism, impaired growth and development, etc.. It should be noted that this treatment does not target the disease, so it does not cure the disease, it only relieves symptoms.

Now, according to recent studies, it appears that the prognosis of these patients is improving as new therapies proved efficient in relieving symptoms and decreasing the dose of corticosteroids. The two biologic drugs were safe and effective in patients with SJIA according to studies. Dr. Rayfel Schneider, Project Investigator and Staff Physician in the Department of Rheumatology at SickKids, said that these children are very difficult to treat and this research is a big step forward in the treatment of patients with SJIA. He added that no unanticipated side effects were observed in them and that, if there were present, adverse reactions were similar of other drugs of the same class.

These therapies use drugs that block molecules involved in inflammation, namely interleukin 6 and interleukin 1. Tocilizumab is a drug that blocks IL-6 and seems to be highly effective, and safe in children with severe and persistent SJIA. After only one year of treatment, one-third of patients had no active disease and almost half dropped completely to treatment with corticosteroids.

Canakinumab, another drug that inhibits interleukin-1 beta, has been evaluated in two studies. First it was tested whether this drug is effective in controlling fever and arthritis, and in the other study it was evaluated the efficacy and safety of this drug in the management of patients with SJIA. It was found that even a single administration of the drug can inactivate disease and that after 7 months of treatment patients did not need steroid treatment.