PMID- 25227771
OWN - NLM
STAT- MEDLINE
DCOM- 20151214
LR  - 20220331
IS  - 1434-9949 (Electronic)
IS  - 0770-3198 (Print)
IS  - 0770-3198 (Linking)
VI  - 34
IP  - 3
DP  - 2015 Mar
TI  - A prospective study comparing infection risk and disease activity in children 
      with juvenile idiopathic arthritis treated with and without tumor necrosis 
      factor-alpha inhibitors.
PG  - 457-64
LID - 10.1007/s10067-014-2779-8 [doi]
AB  - Tumor necrosis factor-alpha (TNF-alpha) inhibitors are effective treatment for 
      juvenile idiopathic arthritis (JIA) but may increase infection rates. However, 
      active JIA may also render patients vulnerable to infection. In this study, we 
      prospectively assessed infection rates in JIA patients treated with and without 
      TNF-alpha inhibitors and correlated disease activity with infection risk. TNF-alpha 
      inhibitor-naive JIA subjects were followed up for 12 months. Subjects initiated 
      on TNF-alpha inhibitors after enrollment were analyzed in the TNF group. Subjects 
      treated without TNF-alpha inhibitors were analyzed in the non-TNF group. 
      Questionnaires captured mild or severe infections. JIA disease activity by 
      Childhood Health Assessment Questionnaire (CHAQ) disability index/pain score and 
      physician joint count/global assessment was recorded. Twenty TNF and 36 non-TNF 
      subjects were analyzed. The total infection rate ratio for TNF versus non-TNF 
      group subjects was 1.14 (95% CI, 0.78-1.66; p = 0.51). The average rate of 
      infections per month was 0.29 for TNF and 0.24 for non-TNF subjects. No severe 
      infections or hospitalizations occurred in either group. Secondary infectious 
      outcomes were also similar between groups. Controlling for study group, an 
      increase in CHAQ pain score correlated with an increase in several infectious 
      outcome measures. Our results suggest no difference in infection rates between 
      JIA subjects treated with and without TNF-alpha inhibitors. Additionally, JIA disease 
      activity may have contributed to infection risk in our cohort, irrespective of 
      immunosuppressive therapy. Future analysis of the relationship between treatment 
      regimens, disease activity, and infection rates may help to further delineate 
      predictors of infection risk in JIA patients.
FAU - Walters, Heather M
AU  - Walters HM
AD  - Department of Pediatric Rheumatology, Hospital for Special Surgery, 535 East 70th 
      Street, New York, NY, 10021, USA, heather.marie.walters@gmail.com.
FAU - Pan, Nancy
AU  - Pan N
FAU - Lehman, Thomas J A
AU  - Lehman TJ
FAU - Adams, Alexa
AU  - Adams A
FAU - Huang, Wei-Ti
AU  - Huang WT
FAU - Sitaras, Lemonia
AU  - Sitaras L
FAU - Cunningham-Rundles, Susanna
AU  - Cunningham-Rundles S
FAU - Walsh, Thomas J
AU  - Walsh TJ
FAU - Toussi, Sima S
AU  - Toussi SS
LA  - eng
GR  - UL1 RR024996/RR/NCRR NIH HHS/United States
GR  - UL1 TR000457/TR/NCATS NIH HHS/United States
GR  - UL1-RR024996/RR/NCRR NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20140918
PL  - Germany
TA  - Clin Rheumatol
JT  - Clinical rheumatology
JID - 8211469
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Tumor Necrosis Factor-alpha)
RN  - FYS6T7F842 (Adalimumab)
RN  - OP401G7OJC (Etanercept)
SB  - IM
MH  - Adalimumab/adverse effects
MH  - Adolescent
MH  - Antirheumatic Agents/*adverse effects
MH  - Arthritis, Juvenile/complications/*drug therapy
MH  - Child
MH  - Child, Preschool
MH  - Etanercept/adverse effects
MH  - Female
MH  - Humans
MH  - Infant
MH  - Infections/*etiology
MH  - Male
MH  - Prospective Studies
MH  - Severity of Illness Index
MH  - Tumor Necrosis Factor-alpha/*antagonists & inhibitors
MH  - Young Adult
PMC - PMC4351171
MID - NIHMS652795
EDAT- 2014/09/18 06:00
MHDA- 2015/12/15 06:00
PMCR- 2015/03/05
CRDT- 2014/09/18 06:00
PHST- 2014/06/17 00:00 [received]
PHST- 2014/09/07 00:00 [accepted]
PHST- 2014/08/25 00:00 [revised]
PHST- 2014/09/18 06:00 [entrez]
PHST- 2014/09/18 06:00 [pubmed]
PHST- 2015/12/15 06:00 [medline]
PHST- 2015/03/05 00:00 [pmc-release]
AID - 10.1007/s10067-014-2779-8 [doi]
PST - ppublish
SO  - Clin Rheumatol. 2015 Mar;34(3):457-64. doi: 10.1007/s10067-014-2779-8. Epub 2014 
      Sep 18.