| Part 1 Clinical features of non-systemic juvenile idiopathic arthritis Objective:To analyze the clinical characteristics of non-systemic juvenile idiopathic arthritis and compare the differences between subtypes of juvenile idiopathic arthritis in order to improve the understanding of the disease.Methods:The clinical data of untreated non-sJIA patients diagnosed in the Department of General Medicine of the Second Hospital of Shanxi Medical University from January2021 to January 2023 were collected and their clinical characteristics were summarized..Results:A total of 67 non-sJIA cases(32 cases of oJIA,21 cases of pJIA,14 cases of ERA)were collected,including 34 males and 33 females,with a male to female ratio of about1.03 ∶ 1.The age of onset was from 1 to 16 years old,with an average of 10.51 ± 4.08 years old.The male to female ratios of oJIA,pJIA and ERA were 1.13 ∶ 1,0.4 ∶ 1 and3.67 ∶ 1,respectively.pJIA was more common in women,and ERA was more common in men.The average age of onset was 9.0 ± 4.41 years old,11.90 ± 3.43 years old,and11.86 ± 3.03 years old,respectively.There were significant differences in gender composition and age of onset amongJIA subtypes(P < 0.05).Among the affected joints,the most commonly affected joint was the knee joint,accounting for 70.15 %.Among them,the most commonly affected joints of oJIA and pJIA patients were the knee joint,accounting for 84.38 % and 71.43 % respectively.The most commonly affected joint in ERA patients was the hip joint,accounting for 57.14 %.There were significant differences in wrist joint,proximal interphalangeal joint,knee and hip joint involvement amongJIA subtypes(P < 0.05).In terms of laboratory tests,the incidence of ESR increase was 41.79 %,of which pJIA was the most,57.14 % of patients had ESR increase,and oJIA was the least,only 31.25 %.There was no significant difference betweenJIA subtypes(P > 0.05).The incidence of increased CRP was 32.84 %,of which pJIA was the most,52.38 % of patients had increased CRP,and ERA was the least,only 14.29 %.The difference betweenJIA subtypes was statistically significant(P <0.05).The positive rates of RF,ANA,anti-CCP antibody and anti-MCV antibody were17.91 %,14.93 %,13.43 % and 11.84 % respectively,which were the most common in pJIA.The positive rates were 38.10 %,19.05 %,28.57 % and 28.57 % respectively,which were the least common in ERA.There were significant differences in the positive rates of RF and anti-MCV antibodies amongJIA subtypes(P<0.05).Among all the cytokines detected,the incidence of elevated TNF-α was the highest,accounting for70.97 %,followed by IL-6,accounting for 51.61 %.In oJIA,pJIA and ERA,the incidence of elevated TNF-α was 60 %,85 % and 75 %,respectively,there was no significant difference in the incidence of TNF-α elevation amongJIA subtypes(P >0.05).The incidence of IL-6 elevation was pJIA(80.00 %)> oJIA(46.67 %)> ERA(16.67 %),and the difference was statistically significant(P < 0.05).The average JADAS27 score of the included patients was 15.81 ± 7.04,of which the score of pJIA patients was 21.98 ± 5.36,and the oJIA score was 11.76 ± 4.68.The score of pJIA patients was significantly higher than that of oJIA,and the difference was statistically significant(P < 0.05).The lowest value of JADAS27 was 5 points,and the highest value was 34.4 points.According to the disease activity index,the newly diagnosed patients were at least in moderate or even high disease activity.Conclusion:Our study found that oJIA is the most common in oJIA,pJIA and ERA.In terms of gender composition,pJIA is more common in women,and ERA is more common in men;in terms of age of onset,oJIA is the earliest.The most commonly affected joints in oJIA and pJIA patients were knee joints,and ERA was hip joints.In the active stage of the disease,ESR and CRP were increased,and some patients were positive for autoantibodies.The positive rates of RF and anti-MCV antibody in pJIA patients were the highest.Among cytokines,the increase of TNF-α and IL-6 levels is the most common,especially in pJIA,which may be most closely related to the occurrence and development of non-sJIA.Part 2 Follow-up study of TNF-α antagonist in the treatment of non-systemic juvenile idiopathic arthritisObjective:To investigate the efficacy and safety of TNF-α antagonist adalimumab and etanercept in the treatment of non-sJIA,and to compare them with each other,as well as the difference between the two in different subtypes ofJIA,so as to guide clinical medication,optimize the diagnosis and treatment of non-sJIA patients,and promote the disease remission and healthy growth of non-sJIA patients.Methods:Forty patients with non-sJIA who were treated with conventional non-steroidal antiinflammatory drugs(NSAIDs)and disease modifying anti-rheumatic drugs(DMARDs)for 3 months and whose disease improvement was less than 50 % or recurred,still had active arthritis,or had poor prognostic factors or complications were selected.According to the common decision of doctors and patients,TNF-α antagonist adalimumab or etanercept was selected for treatment.And signed informed consent.Follow-up was performed at 1,3,6,and 12 months after treatment.ESR,CRP,and JADAS27 were used to evaluate the disease activity,and ACRPedi30/50/70/90 was used to evaluate the overall improvement of the disease.To evaluate the efficacy of adalimumab and etanercept,compare and analyze the differences between the two and their effectiveness in different subtypes ofJIA.At the same time,adverse reactions during treatment were recorded to evaluate safety.Results:Among the 40 non-sJIA children,there were 15 cases of oJIA,14 cases of pJIA and 11 cases of ERA.There were 23 males and 17 females,with a male to female ratio of about 1.35 ∶ 1.The age of onset was between 1 and 16 years old,with an average of 10.55 ± 4.06 years old.27 cases were treated with adalimumab and 13 cases were treated with etanercept.In terms of controlling inflammatory response,both adalimumab and etanercept can effectively reduce the levels of inflammatory markers ESR and CRP.In the adalimumab group,the ESR levels at 6 and 12 months follow-up and the CRP levels at 3,6 and 12 months follow-up were significantly lower than those before treatment(P < 0.05).In the etanercept group,ESR and CRP levels were significantly lower than those before treatment at 1,3,6 and 12 months after treatment(P < 0.05).There was no significant difference between the two groups(p > 0.05).In differentJIA subtypes,the levels of ESR and CRP at 1,3,6 and 12 months after treatment were significantly lower than those before treatment(P 0.05).In addition,there was no significant difference between the two in differentJIA subtypes(p > 0.05).In the overall assessment of disease activity,both adalimumab and etanercept could rapidly reduce the JADAS27 score.At 1,3,6,and 12 months after treatment,the JADAS27 score was significantly lower than that before treatment(P < 0.05).And there was no significant difference between oJIA and pJIA(P > 0.05).In terms of improving the overall assessment of the disease,adalimumab and etanercept can improve the condition of non-sJIA children.The ACRPedi30/50/70/90 compliance rates of the adalimumab group after 1,3,6,and 12 months of treatment were 72.00 %/64.00 %/16.00 %/12.00 %,78.95 %/73.68 %/57.89 %/42.11 %,70.00 %/70.00 %/70.00 %/50.00 %,100.00 %/100.00 %/100.00 %/50.00 %;The ACRPedi30/50/70/90 compliance rates at 1,3,6,and 12 months of treatment in the etanercept group were 75.00 %/66.67 %/41.67 %/25.00 %,91.67 %/91.67 %/91.67 %/75.00 %,100.00 %/100.00 %/100.00 %/88.89 %,75.00 %/75.00 %/75.00 %/75.00 %,respectively.There was no significant difference in the ACR30/50 compliance rate between the two groups(P > 0.05).The ACR70/90 compliance rate of etanercept group was significantly better than that of adalimumab group(P < 0.05).In terms of safety,no serious adverse events occurred during the treatment,mainly local reactions at the injection site,followed by 2 cases(5 %)with elevated liver enzymes,1 case(2.5 %)with rash,and 1 case(2.5 %)with abdominal pain,but all were mild and improved after symptomatic treatment.Conclusion:TNF-α antagonists adalimumab and etanercept can effectively reduce the inflammatory response and control disease activity.In terms of controlling inflammatory response,although etanercept reduces inflammation indicators quickly and significantly,there is no significant difference between the two.Among theJIA subtypes,both of them had the best effect in the treatment of pJIA,and the inflammatory indicators improved rapidly and significantly,and there was no significant difference between the two.In terms of improving the overall activity of the disease,both of them can quickly and effectively reduce the JADAS27 score,and have significant effects on oJIA and pJIA,with no significant difference between the two.In terms of improving the overall evaluation of the disease,adalimumab and etanercept can improve the condition of nonsJIA children.The ACRPedi70/90 compliance rate of etanercept was significantly higher than that of adalimumab group,and its efficacy may be better than adalimumab.For each subtype ofJIA,there was no significant difference in the overall efficacy of TNF-α antagonists(adalimumab,etanercept).In addition,adalimumab and etanercept were safe without serious adverse reactions. |
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