Jra steroid treatment

Abatacept has been approved by the FDA for use in reducing signs and symptoms of moderately to severely active polyarticular juvenile RA (juvenile idiopathic arthritis) in pediatric patients 6 years and older.  The approval was based on data from the AWAKEN study (Abatacept Withdrawal study to Assess efficacy and safety in Key Endpoints in juvenile idiopathic arthritis Not responding to current treatment), a 3-part study including an open-label extension in children with polyarticular juvenile RA.  Overall, the 3-part trial showed that abatacept therapy yielded improvements across 3 major subtypes of juvenile RA through 1 year in patients aged 6 to 17 years whose disorder had not responded to 1 or more DMARDs, such as methotrexate or tumor necrosis factor (TNF) antagonists.  Patients had a disease duration of approximately 4 years with moderately to severely active disease at study entry, as determined by baseline counts of active joints (mean of 16) and joints with loss of motion (mean of 16); patients had elevated C-reactive protein (CRP) levels (mean of  mg/dL) and ESR (mean of 32 mm/h).

Disease modifying drugs - commonly called DMARDs - are added as a second-line treatment when arthritis involves many joints or does not respond to steroid joint injections. DMARDs include methotrexate (Rheumatrex), leflunamide (Arava), and more recently developed medications known as biologics. The biologics include anti-tumor necrosis factor agents such as etanercept ( Enbrel ), infliximab (Remicade), adalimumab (Humira),  abatacept (Orencia),  anakinra (Kineret;), canakinumab (Ilaris), tocilizumab (Actemra), and rituximab (Rituxan). Each of these medications may cause side effects that need to be monitored and discussed with the pediatric rheumatologist treating your child. Many of these treatments are approved for use in children as well as adults. In addition, researchers are developing new treatments.

Treatment guidelines, based upon presence or absence of active systemic features, clinician global assessment, active joint count, and presence or absence of features concerning for macrophage activation syndrome (MAS), are outlined by the American College of Rheumatology (ACR) [ 2 ]. These guidelines emphasize the earlier use of biologics in children with sJIA, although specific information on appropriate dose is lacking. Another set of standardized treatment plans was developed through a consensus process by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) based upon the most commonly used treatment approaches for systemic JIA [ 3 ].

An infusion reaction was defined in clinical trials as any adverse event occurring during an infusion or within 1 hour after an infusion. In Phase 3 clinical studies, 18% of Remicade-treated patients experienced an infusion reaction compared to 5% of placebo-treated patients. Of infliximab-treated patients who had an infusion reaction during the induction period, 27% experienced an infusion reaction during the maintenance period. Of patients who did not have an infusion reaction during the induction period, 9% experienced an infusion reaction during the maintenance period.

The battle is long. The MERSI experience suggests that at least 2 years on immunomodulatory agents is necessary. The idea is to allow the patient’s immune system to re-learn how to behave itself properly instead of being hyperactive, inappropriate, or aggressive. Immunomodulation suppresses this over activity and inappropriateness, making (artificially) the immune system behave more normally. The goal of such treatment is not to over-suppress the immune system as is sometimes required in treating transplant or cancer patients; rather, the immune system is modulated, re-regulated, until it stops attacking the eye(s). Are there risks to this strategy? Sure. Are the risks worth taking? In the MERSI experience, absolutely. Because the risks are small and manageable if the medications are prescribed and monitored by an expert in these matters, and the benefits are enormous, . preservation of sight and prevention of blindness for the rest of one’s life. Chronic steroid use ALWAYS causes damage. This is why doctors advocate getting away from that plan of treatment, and moving on to non-steroidal agents.

Jra steroid treatment

jra steroid treatment

An infusion reaction was defined in clinical trials as any adverse event occurring during an infusion or within 1 hour after an infusion. In Phase 3 clinical studies, 18% of Remicade-treated patients experienced an infusion reaction compared to 5% of placebo-treated patients. Of infliximab-treated patients who had an infusion reaction during the induction period, 27% experienced an infusion reaction during the maintenance period. Of patients who did not have an infusion reaction during the induction period, 9% experienced an infusion reaction during the maintenance period.

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