Analysis Of The Efficacy Of Tumor Necrosis Inhibitor Therapy In Nonsystemic Juvenile Idiopathic Arthritis

Objective:To analyze the efficacy of tumor necrosis factor(TNF)inhibitor Adamumab or enalapril in patients with non-systemic juvenile idiopathic arthritis(JIA),and the clinical value of musculoskeletal ultrasound.Methods:Retrospective analysis of data from November 2020 to November 2022 from patients with a definite diagnosis of non-systemic JIA at the first visit to the inpatient and outpatient departments of the Department of Family Medicine,Second Hospital of Shanxi Medical University.Efficacy analysis was performed on patients who received adalimumab or etanercept for the first time and were followed up at least once after baseline,and 40 cases were collected.All patients were treated with both Non-Steroidal Anti-Inflammatory Drugs and Disease Modifying Anti-Rheumatic Drugs and were divided into adalimumab(n=27)and etanercept(n=13)groups according to the type of biologic agent used.The general demographic characteristics and JIA clinical data(gender,age,diagnosis,joint involvement),laboratory tests and assessments(erythrocyte sedimentation rate,C-reactive protein,physician global assessment of overall disease activity,parent ssessment of overall well-being,and childhood health assessment questionnaire(CHAQ)),and musculoskeletal ultrasound fluid depth and synovial thickness were recorded and followed up at weeks 4,12,and 24 of treatment.According to the Pediatric American College of Rheumatology Criteria(ACR Pedi)response rates 、 27 joint juvenile arthritis disease activity scores(JADAS27)、CHAQ and musculoskeletal ultrasound results to assess the efficacy of the treatment.The SPSS26.0 software was used to describe and analyze the data.T-test or nonparametric rank sum test were used to compare the measurement data between groups.χ~2 test was used to compare the counting data rate.The repeated measurement data were analyzed by generalized estimation equation.The test level is α = 0.05.Results:Comparison of ACR Pedi response rates at different time points: at 4,12 and 24 weeks of treatment,the ACR Pedi 30 response rates were 70.4%,69.6%,88.2% in the adalimumab group and 69.2%,100.0%,100.0%in the etanercept group;the ACR Pedi 50response rates were 70.4%,69.6%,88.2%in the adalimumab group and 61.5%,100.0%,91.7%in the etanercept group;the ACR Pedi 70 response rates were 14.8%,56.5%,76.5%in the adalimumab group and 88.2%in the Adalimumab group and 61.5%,100.0%,91.7%in the Etanercept group;ACR Pedi 70 response rates were 14.8%,56.5%,76.5%in the Adalimumab group and 30.8%,84.6%,91.7%in the Etanercept group;ACR Pedi 90response rates were 11.1%,43.5%,64.7%in the Adalimumab group and 23.5%in the Etanercept group and 23.1%,69.2%,and 91.7%in the etanercept group.The ACR Pedi 30,50,70,and 90 response rates in both groups further improved or stabilized with increasing treatment duration(P<0.001);When comparing between groups at each time point,the ACR Pedi 30 and 50 response rates were better in the etanercept group than in the adalimumab group at the end of treatment 12 weeks,with a statistically significant difference(P=0.034).At the remaining time points,there was no statistically significant difference in ACR Pedi30,50,70,and 90 response rates between groups(P>0.05).Comparison of JADAS27 at different time points: JADAS27 was used to assess the disease activity of oligoarticular JIA(o JIA)and polyarticular JIA(p JIA),both the etanercept and adalimumab groups significantly reduced the JADAS27 of o JIA and p JIA patients as the duration of treatment increased(P < 0.001);the difference between the JADAS27 groups at each time point was not statistically significant(P > 0.05).Comparison of CHAQ scores at different time points: Patients with non-systemic JIA treated with adalimumab or etanercept had significantly lower CHAQ scores in both the adalimumab and etanercept groups as the duration of treatment increased(P<0.001).The differences between the two groups in CHAQ scores at the end of 4,12,and 24 weeks of treatment were not statistically significant(P > 0.05).Comparison of musculoskeletal ultrasound after 24 weeks of treatment: there was a reduction in joint effusion after 24 weeks of treatment in the adalimumab and etanercept groups compared to baseline,but the difference was not statistically significant(P > 0.05).The median difference in synovial thickness after treatment in the etanercept group was-0.25(0.55)cm,a statistically significant difference(P=0.028).Conclusion:The combination of adalimumab or etanercept for 24 weeks in patients with nonsystemic JIA has shown good results.Both the combination of adalimumab and etanercept provided rapid control of signs and symptoms,reduced erythrocyte sedimentation rate and C-reactive protein levels,and sustained improvement in disease activity and quality of life,with comparable overall efficacy.Compared with the adalimumab group,the non-systemic JIA patients had better response rates to ACR Pedi 30 and 50 in the etanercept group at 12 weeks.In addition,efficacy was assessed by musculoskeletal ultrasound,and synovial thickness was reduced at 24 weeks with combined etanercept treatment,but neither combined adalimumab or etanercept treatment was significant in terms of reducing joint effusion.