INTRAVENOUS IMMUNOGLOBULIN THERAPY IN SYSTEMIC-ONSET JUVENILE RHEUMATOID-ARTHRITIS - A FOLLOW-UP-STUDY

Objective. To report the short and longterm effect of intravenous immu noglobulin (IVIG) in patients with systemic onset juvenile rheumatoid arthritis (SOJRA). Methods. A retrospective chart review of 27 patient s with SOJRA treated with IVIG and followed for 37.1 +/- 18.2 months w as undertaken. Indications for treatment were fever, arthritis, or ste roid dependency. Results. We treated 27 patients with SOJRA with IVIG monthly for 3-54 months. Six months after IVIG therapy, 20 patients ha d at least a 50% decrease in at least one of the following: the number of days of fever; prednisone dose; or the number of active joints. Fi ve patients failed to respond to IVIG, and 2 dropped out after 3 and 4 months. At last followup visit (mean 37.6 +/- 18 months), 11 of the i nitial 20 responder group patients were in remission, while 3 had sign ificantly improved but still had active arthritis, and 6 were now unre sponsive. Of the initial 5 patients in the nonresponder group, 4 had n onresponsive arthritis and 1 had improved at last followup. Three pati ents in the responder group subsequently developed other diseases. Con clusion. The main benefit of IVIG therapy to most of our patients was a significant improvement in the systemic features, with resolution of fever and a significant reduction in the steroid dose. The efficacy o f IVIG in altering the course of arthritis was less predictable. We su ggest that IVIG has a role in the management of SOJRA, but it should b e limited to patients with severe SOJRA in whom prolonged unresponsive ness to standard therapy is present.