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Infection-Related Death among Persons with Refractory Juvenile Idiopathic Arthritis

Mario Abinun, Jonathan P Lane, Mark Wood

    Emerging Infectious Diseases
    |September 21, 2016
    PubMed

    Insights

    Children with severe juvenile idiopathic arthritis (JIA) face high mortality risks from infections. Aggressive immunosuppressive therapies, including biological DMARDs, increase susceptibility to fatal bacterial and viral infections in JIA patients.

    Area of Science:

    • Pediatric Rheumatology
    • Infectious Diseases
    • Clinical Immunology

    Background:

    • Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease in children.
    • Refractory JIA often requires intensive immunosuppressive therapies, including biological disease-modifying antirheumatic drugs (DMARDs).
    • These treatments increase the risk of severe infections and mortality in pediatric patients.

    Observation:

    • A study reviewed four pediatric deaths related to JIA between 1994 and 2013.
    • Three deaths resulted from severe bacterial sepsis (coagulase-negative Staphylococcus, α-hemolytic Streptococcus) associated with central venous catheters.
    • One death was attributed to disseminated adenovirus and Epstein-Barr virus infection.

    Findings:

    • All four deceased children had active, refractory JIA.
    • They were undergoing long-term treatment with multiple conventional and biological DMARDs.
    • Two patients died while on high-dose corticosteroids, methotrexate, and anti-tumor necrosis factor-α agents; two died during hematopoietic stem cell transplantation.

    Implications:

    • Severe infections pose a significant mortality risk in children with refractory JIA.
    • Close monitoring for infections is crucial for children with JIA on immunosuppressive therapy.
    • Accurate reporting of severe infections and deaths is vital for disease surveillance and improved patient outcomes.

    Keywords:
    Juvenile idiopathic arthritisTNF-α blocking agentsUnited Kingdomanti–TNF-αbacteriabiological disease-modifying drugscentral venous catheter bacteriachildrencombined immunosuppressive and antiinflammatory therapyimmunosuppressionsepsis

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