Objective: To study the short-term efficacy and safety for infliximab in patients with refractory juvenile idiopathic arthritis (JIA).
Methods: Nine patients with JIA were enrolled. Four patients were with systemic onset polyarticular course JIA (sJIA) and 5 patients were with rheumatoid factor positive polyarticular JIA (pJIA). The patients had failed to respond to methotrexate or any other disease modifying anti-rheumatic drugs. Infliximab was given intravenously at weeks 0, 2, 6, and at 4 to 8 week intervals thereafter. Improvement of the patients was assessed at 0, 2, 6, 12, and 24 weeks according to Disease Activity Score (DAS) 28 and JIA core set.
Results: According to DAS28, the sJIA group improved immediately at 2 weeks and 3 patients (75%) obtained more than a moderate response at 24 weeks but one patient worsened from the baseline at 24 weeks. The pJIA group did not achieve a good response until 12 weeks but all 4 patients obtained more than moderate responses except one drop-out case because of human anti-chimeric antibody. JIA core set 70% was achieved at 24 weeks by 2/4 (50%) patients with sJIA and by 4/4 (100%) patients with pJIA without one drop-out case.
Conclusion: In our study, infliximab provided a significant rapid reduction in disease activity in the short term, but response to infliximab differed between sJIA and pJIA patients. More study is needed to elucidate the long term safety and efficacy of infliximab in the treatment of refractory sJIA and pJIA.
