Intraarticular infliximab therapy in patients with juvenile idiopathic arthritis: the role of musculoskeletal ultrasound and disease activity scores in monitoring therapy response.

OBJECTIVES:Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children, with heterogeneous clinical features. Although therapeutic options are wide and in the majority of children symptoms improve with the combination of non-steroidal anti-inflammatory and disease-modifying drugs, there are a number of patients who do not respond to conventional therapy and who do not meet the criteria for systemic biologics, namely anti TNF-alpha. Those patients are potential candidates for intraarticular therapy with biologics and in this report we present the results of intra-articular infliximab treatment in a series of patients diagnosed with oligoarticular subtype of JIA. METHODS:Twenty patients (30 joints) were treated with intraarticular infliximab and monitored by power Doppler musculoskeletal ultrasound according to the OMERACT and Juvenile Arthritis Disease Activity Score (JADAS 10) before intraarticular application and during the follow-up period of 18 months (0, 1, 12, 18 months). RESULTS:The results showed statistically significant improvement in PD-MSUS measures and JADAS in both B mode and power Doppler mode scores (p<0.001, p<0.001, respectively) in patients treated with i.a. infliximab with persistent response in fifteen patients. The JADAS score, as well as the ultrasound scores, were significantly reduced during the follow-up period. CONCLUSIONS:This study showed promising results, good safety and potential for the clinical benefit of intraarticular infliximab treatment in a selected group of patients with oligoarticular subtype of JIA.