TNF-a antagonists for the treatment of juvenile-onset spondyloarthritides 

G. Horneff¹, R. Burgos-Vargas²

¹Department of Paediatrics, Martin-Luther University Halle-Wittenberg, Halle, Germany; ²Research División, Hospital General de México, Mexico City, Mexico

ABSTRACT
Juvenile-onset spondyloarthritides (SpA) is a term for a group of HLA-B27 related disorders. The hallmark signs and symptoms of this group of disorders include peripheral arthritis and enthesitis while sacroiliitis and spondylitis develop in some cases later on and extrarticular manifestations such as anterior uveitis occurs occasionally. Conventional medical therapy in children consists of non-steroidal anti-inflammatory drugs and corticosteroids that are administered intraarticulary, even in the sacroiliac joints. Sulfasalazine and methotrexate are given in cases of chronic synovitis or enthesitis. Unfortunately, these forms of therapy have limited efficacy in many cases and disease activity and damage may lead to various degrees of functional impairment. Recently, experience with TNFa-antagonists in adults has opened new perspectives for treating patients with refractory SpA, particularly ankylosing spondylitis (AS). So far there is only little experience in the treatment of juvenile-onset SpA, consisting of case reports and case series where etanercept or infliximab have been given to children suffering from refractory juvenile-onset AS and psoriatic arthritis. From these observations there is evidence that treatment seems to be as effective as in adults. Risks are likely to be the same as in patients suffering from other forms of juvenile idiopathic arthritides. However, without further studies no recommendations can be provided for indication for treatment, dosing, intervals and duration of treatment. 

Key words
Juvenile arthritis, juvenile-onset spondyloarthritides, etanercept, infliximab.

Please address correspondence to: Dr. Gerd Horneff, Universitütsklinik und Poliklinik für Kinder- und Jugendmedizin, 06097 Halle, Germany. 
E-mail: gerd.horneff@medizin.uni-halle.de

Clin Exp Rheumatol 2002; 20: (Suppl. 28): S137-S142.
© Copyright Clinical and Experimental Rheumatology 2002.