Related Experiment Videos

[Guidelines for prescribing and monitoring biologic therapies in juvenile idiopathic arthritis]

Maria José Santos1, João Eurico Fonseca, Helena Canhão

  • 1Sociedade Portuguesa de Reumatologia, Lisboa.

Acta Reumatologica Portuguesa
|April 25, 2007
PubMed

Insights

The Portuguese Society of Rheumatology recommends biological treatments for children with polyarticular Juvenile Idiopathic Arthritis (JIA) unresponsive to methotrexate. Tuberculosis screening and specific drug approvals guide treatment decisions.

Area of Science:

  • Pediatric Rheumatology
  • Immunology
  • Pharmacology

Context:

  • Juvenile Idiopathic Arthritis (JIA) management requires effective treatments for refractory cases.
  • Polyarticular JIA often necessitates advanced therapeutic strategies.
  • Methotrexate (MTX) is a common first-line therapy, but resistance can occur.

Purpose:

  • To provide recommendations for biological treatment initiation in pediatric polyarticular JIA.
  • To outline alternative therapeutic options when MTX is contraindicated or ineffective.
  • To establish guidelines for monitoring treatment efficacy and safety.

Summary:

  • Biological treatments are recommended for active polyarticular JIA refractory to 3-6 months of MTX (15 mg/m²/week).
  • Alternative conventional Disease Modifying Anti-Rheumatic Drugs (DMARDs) or biologicals can be used if MTX toxicity or contraindication occurs.
  • Screening for latent tuberculosis is mandatory before initiating biological therapy.
  • Treatment suspension is advised if American College of Rheumatology (ACR) improvement criteria are not met in consecutive visits.
  • Etanercept is approved in Portugal; infliximab and anakinra are considered for refractory or systemic JIA, respectively.

Impact:

  • Optimizes treatment selection for pediatric JIA patients.
  • Ensures patient safety through tuberculosis screening and efficacy monitoring.
  • Facilitates evidence-based decision-making for rheumatologists in Portugal.

Related Concept Videos

Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF01:24

Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF

Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab (Humira),...
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
Inflammatory Bowel Disease IV: Pharmacological Management01:29

Inflammatory Bowel Disease IV: Pharmacological Management

Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Therapeutic Drug Monitoring: Overview and Classification01:16

Therapeutic Drug Monitoring: Overview and Classification

Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood at designated intervals to ensure the drug concentration stays within a therapeutic range. This monitoring is crucial for optimizing individual dosage regimens, enhancing therapeutic efficacy, and minimizing drug-related toxicity. TDM is vital for drugs with narrow therapeutic windows, significant variability in pharmacokinetics, and a clear correlation between plasma levels and...
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids01:21

Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids

Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2 (COX-2),...
Drug Dosage Regimen: Overview01:15

Drug Dosage Regimen: Overview

A drug dosage regimen describes the specific instructions and schedule for administering a drug to a patient. It considers factors such as drug dosage, frequency, route of administration, and duration of treatment. Designing an appropriate dosage regimen for a patient aims to achieve a target drug concentration at the site of action.
Typically, the starting dose and dosing interval are guided by the manufacturer's recommendations based on clinical trials conducted during and after drug...