The British Journal of Rheumatology, Vol 36, 589-593, Copyright © 1997 by British Society for Rheumatology
MJ Elliott, P Woo, P Charles, A Long-Fox, JN Woody and RN Maini
Juvenile chronic arthritis (JCA) is the commonest chronic rheumatic
disorder of childhood. Although conventional therapy of JCA continues to
improve, many patients experience long-term ill health as a result of their
disease or treatment. In adult rheumatoid arthritis (RA), similar concerns
have led to the development of therapies designed to interfere in key
disease processes. One such therapy is cA2, a chimeric neutralizing
monoclonal antibody to the inflammatory cytokine, tumour necrosis
factor-alpha (TNF-alpha). The administration of cA2 in adult RA has led to
impressive short-term suppression of disease, with a good safety profile.
Here, we report the first use of cA2 in childhood arthritis, choosing a
patient with severe systemic-onset JCA, resistant to conventional
therapies. The patient received two i.v. infusions of cA2, each at a dose
of 10 mg/kg, separated by 1 week. The treatment was well tolerated and
induced rapid control of fever, anorexia and serositis, together with
downregulation of interleukin (IL)-6, soluble TNF receptors (sTNFR) and
IL-1ra, and the acute-phase proteins C- reactive protein (CRP) and serum
amyloid A (SAA). In contrast, we saw no significant improvement in joint
pain or tenderness. Our findings suggest that TNF-alpha is a mediator of
fever and other systemic aspects of disease in systemic JCA. TNF-alpha
blockade as a treatment modality in JCA deserves further study.
ORIGINAL PAPERS
Suppression of fever and the acute-phase response in a patient with juvenile chronic arthritis treated with monoclonal antibody to tumour necrosis factor-alpha (cA2)
Kennedy Institute of Rheumatology, Hammersmith, London.
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