Clinical effect evaluation of the recombinant Ⅱ type of tumor necrosis factor receptor antagonists treatment of juvenile idiopathic arthritis / 中华实用儿科临床杂志

Objective To observe the short-term,long-term clinical results and complications in refractory juvenile idiopathic arthritis (JIA) treating with TNF-α inhibitors,and to compare 2 evaluation systems.Methods A retrospective review of 52 cases of patients with refractory JIA in Shenzhen Children's Hospital was performed.With reference to International Leagne of Associations for Rheumatology(ILAR)2001 diagnostic criteria,the patients were divided into 4 groups:26 polyarticular JIA patients,14 systemic JIA patients,9 oligoarticular JIA patients and 3 other types of patients.The children with JIA were based on the conventional treatment such as Methotrexate,combination of TNF-α inhibitors treatment.The short-term and long-term clinical outcomes were evaluated and compared with American College of Rheumatology (ACR) and Juvenile Arthritis Disease Activity Score (JADAS).Complications in each group were recorded.Results (1) Short-term outcome assessment:ACR 50 were achieved in 69.2％ of the polyarticular JIA,66.7％ in oligoarticular and 35.7％ in systemic JIA patients on the third month;and by the time of the sixth month it reached to 73.0％ in polyarticular JIA,77.7％ in oligoarticular JIA and 14.3％ in systemic JIA patients on the sixth month.Significant improvement of JADAS after the treatment was observed in each type of JIA,and the differences were statistically significant(all P ＜ 0.05).(2) Long-term outcome assessment:except for the cases missing follow-ups and withdrawal cases,46 patients were able to complete 2 years assessments:according to ACR,effective rate was 84.0％ in polyarticular JIA (21/25 cases),50.0％ in oligoarticular JIA (4/8 cases) and 7.7％ in systemic (1/13 cases) JIA patients;JADAS was significantly decreased in polyarticular JIA patients (76.0％,19/25cases) (P ＜ 0.05),while significant improvement was not observed in oligoarticular JIA and systemic JIA patients(P ＞ 0.05).(3) Complications of upper respiratory tract infection (23.0％,12 cases) and local reaction in injection site (7.6％,4 cases) were noticed.Higher risks of tuberculosis infection and malignancy were not observed.Conclusions (1) TNF-α inhibitors treatment showed a better short-term and long-term outcome in polyarticular and oligoarticular JIA patients,and it may also improve short-term outcome in systemic JIA but with poorer long-term outcome.(2)Two evaluated systems (ACR and JADAS) were well relative,but ACR was capable to compare clinical course between different types of JIA.(3) TNF-α inhibitors treatment was relatively safe with unremarkable adverse reactions.

Natural Course of Crohn's Disease and Novel Treatment Drugs / 대한내과학회지

Crohn's disease is a chronic recurrent inflammatory disease, mainly affecting the gastrointestinal tract. The pathogenesis of inflammatory bowel disease is believed to be caused by the complex interplay of many factors including host genetic susceptibility, the external environment such as infectious agents or the commensal enteric flora, and the immune system dysfunction. Advances in the understanding of the pathophysiology of inflammatory bowel disease have resulted in the development of multiple biological agents that all represent an alternative to the use of current therapies in patients with refractory Crohn's disease. Moreover, these biologic agents are expected to change the natural course of inflammatory bowel disease. Among them, anti-tumor necrosis factor (TNF)-alpha agent is the first developed drug, and it dramatically improved the IBD management. However, more than one-third of the patients do not respond to the drugs due to antibody formation and loss of response. To increase treatment efficacy, enormous efforts have been made to develop novel anti-cytokines which can be an alternative to anti-TNF-alpha agents. They are anti-CD4+ T cell cytokines including interleukin (IL)-12/23, IL-17A, and IFN-gamma blockers, selective anti-adhesion molecules, anti-inflammatory cytokine IL-10, and immune stimulators. This paper reviews the natural history of Crohn's disease, natural course modifiers, and the efficacy and safety of biologic agents other than anti-TNF alpha agents.

Recent Trend in the Treatment of Rheumatoid Arthritis / 대한정형외과학회잡지

Rheumatoid arthritis (RA) is a chronic and destructive inflammatory disease resulting in disability. During the past 10 years, developments in medical science have improved RA treatment significantly, but have not proven curative. The most important developments over the past 10 years are the followings: 1) an emergence of new therapeutic agent against a specific single molecule or target, including biologic and chemical agents, 2) development and clinical usage of various outcome measures to detect disease activity more accurately and 3) introduction of new strategies in the treatment such as early and aggressive combination trials, depending on the disease activity. Over the course of these activities, we have been able to control clinical symptoms and signs more effectively, and slow the destruction of the joint, and finally improve the quality of life in RA patients. Here, we discuss the recent development of RA treatment and a perspective on future development.

Use of an enzyme-linked immunospot assay for diagnosing latent tuberculosis infection in rheumatic diseases / 中华风湿病学杂志

Objective To compare the efficacy of the conventional PPD skin test and a new enzymelinked immunospot assay(TSPOT-TB)for diagnosing latent tuberculosis infection(LTBI)in patients with rheumatic diseases.Methods Two hundred and sixty rheumatic patients were enrolled,and all were screened for LTBI based on clinical history,chest X-ray,PPD skin test or TSPOT.Results The positive rate of TSPOT assay was 24.1%and that of PPD skin test was 39.4%.The overall concordance rate between the 2tests was 61.0%.Among PPD negative patients (n=149).29 were TSPOT(+)(19.5%).Among PPD(+)patients(n=98),69 were TSPOT(-)(70.0%).The patients who got BCG vaccination or had history of tuberculosis infection showed a significantly higher rate of positive result of PPD skin test than those who did not (P<0.05 or P<0.01).While in TSPOT assay,the BCG vaccination or history of tuberculosis infection did not show influence on TSPOT results(P>0.05).Of the 127 patients who received biological agents after screening for LTBI,9 patients were pretreated with isoniazide.Twenty-seven patients stopped biological agent treatment because of the positive results of PPD or TSPOT.Twenty three patients who had positive PPD but negative TSPOT results received biological agent treatment without isoniazide,and none of them developed active tubereulosis after 6 to 18 months of follow-up.Conclusion BCG vaccination affects the result of PPD test in rheumatic patients,but has no influence on TSPOT results.The infection rate of latent tuberculosis of rheumatic patients in our research is 23.8%detected by TSPOT.

Advances in ulcerative colitis therapy / 대한내과학회지

Ulcerative colitis is an idiopathic inflammatory bowel disease characterized by colonic mucosal inflammation and chronic relapsing episodes. The initial therapeutic approach depends on both the extent of colonic involvement and the severity of the disease process at presentation. The mainstay of ulcerative colitis therapy is the administration of 5-aminosalicylic acid (5-ASA) or steroid. Additional medical therapy or colectomy should be considered if the patient remains symptomatic despite conventional therapy, regardless of the extent of colonic involvement. Cyclosporins are effective as a short-term rescue therapy for steroid-refractory ulcerative colitis. Recently, new 5-ASA and steroid formulations with altered delivery, dosing regimens, and less frequent administration have been introduced and demonstrated to be efficacious in active mild to moderate colitis. Infliximab is given to try to avoid the need for colectomy and has proven efficacious in ulcerative colitis. This review outlines the standard therapy for ulcerative colitis and discusses new insights into the recent trend focusing on new therapies, including biological agents and leukocytapheresis.

New drugs for Rheumatoid arthritis / 대한내과학회지

Since the late 1990s, based on scientific advancement and biotechnological improvement, many effective drugs such as leflunomide and biologic agents for rheumatoid arthritis (RA) have been developed. These include TNF-alpha inhibitors such as etanercept, infliximab, and adalimumab, a peripheral B-cell depleting agent such as rituximab, CTLA-4 Ig such as abatacept, and IL-1 receptor antagonist such as anakira. These new agents have provided good efficacy in the treatment of patents with severe or refractory rheumatoid arthritis and have provided retardation or prevention of radiographic progression or joint destruction despite some side effects such as tuberculosis, infection, malignancies. In this review, new therapeutic alternatives would be given, and chances for more improved outcomes in the care of patients with rheumatoid arthritis provided.