Recaídas de artritis crónica juvenil luego de la suspensión de atenercept / Flares in juvenile chronic artritis after withdrawal of etanercept

RESUMEN

Introducción. El etanercept es un medicamento bloqueante del factor de necrosis tumoral de probada eficacia y seguridad en el tratamiento de la artritis crónica juvenil de curso poliarticular refractariaal tratamiento con otros fármacos, comometotrexato. Sin embargo, se desconoce qué ocurrecon la actividad de la enfermedad luego de la suspensión de etanercept en pacientes que responden al tratamiento. Objetivo. Describir la evolución de la artritis crónica juvenil de curso poliarticular en pacientes que mejoraron con etanercept y que posteriormente suspendieron el tratamiento. Población, material y métodos. Se evaluaron pacientes con artritis crónica juvenil de curso poliarticular refractaria al metotrexato que recibieron etanercepty mejoraron. Se incluyeron los pacientes que debieron suspender el tratamiento con etanercept porcausas no médicas.Se evaluaron en sucesivas visitas diferentes indicadores clínicos de actividad y la eritrosedimentación; se definieron, además, mejoría y recaída. Se compararon los valores de esos indicadores en lasvisitas inmediatamente anteriores y posteriores a lasuspensión de etanercept...

ABSTRACT

Introduction. Etanercept is a drug that blocks tumor necrosis factor-alpha, of proven efficacy and safety in the treatment of polyarticular juvenile chronic arthritis refractory to other treatments, such as methotrexate. However, disease activity after discontinuation in patients who respond to etanercept is unknown. Objective. To describe the clinical course of polyarticular course juvenile chronic arthritis in patients who responded to etanercept and subsequently discontinued the treatment. Population, materials and methods. Patients with polyarticular juvenile chronic arthritis refractory to methotrexate who received etanercept and experienced an improvement. Patients who had to discontinue treatment with etanercept for nonmedical reasons were included. Several clinical measures of activity and erythrocyte sedimentation rate were assessed in consecutive visits; definitions of improvement and relapse were provided. Comparisons of the values of these measures were done between visits recorded before and after etanercept withdrawal. Results. Of 20 patients with juvenile chronic arthritis (17 with systemic onset, 2 with polyarticular onset, and 1 with oligoarticular onset) who reached improvement with etanercept treatment, 7 (all with systemic arthritis) had to discontinue this treatment 5.5 months after its initiation. In all cases, interruption of treatment was due to social security termination of drug supply. These 7 patients showed relapse within one month after etanercept withdrawal. In all cases, the relapse was especially characterized by an increase in the number of swollen joints, the number of joints with limitation in range of motion, and in the erythrocyte sedimentation rate. Reappearance of fever and cutaneous rash was observed in one patient. Of the 13 patients who did not suspend treatment with etanercept, 6 showed relapses (all had systemic onset arthritis). Conclusions. Withdrawal of etanercept treatment in patients with...