AZATHIOPRINE IN PATIENTS WITH JUVENILE CHRONIC ARTHRITIS - A LONG-TERM FOLLOW-UP-STUDY

Objective. To evaluate drug survival, efficacy, side effects, and long term toxicity of azathioprine treatment in patients with juvenile chro nic arthritis (JCA). Methods. In an uncontrolled, prospective study we evaluated 179 consecutive patients with JCA refractory to therapy in whom azathioprine treatment was begun during 1980-1989. In the first 2 9 patients, a 2 year trial was planned, while for the remaining 100 pa tients the protocol was to continue until remission or dropout. The me dian treatment period was 13 months (range 3 days-8.5 yrs). Patients w ere assessed every 2 months for 2 years for efficacy, side effects, gr owth and need for glucocorticoids, and outcome evaluated in late 1996. Results. Remission without drugs was attained in 19 patients (15%); i n addition, temporary remission in patients continuing treatment was a ttained in 18 cases (14%). Treatment was discontinued due to side effe cts in 18 cases (14%); in two-thirds of these cases side effects occur red during the first 2 months. Of the total number of patients, 49 (38 %) completed 2 years of treatment, with significant improvement in bot h clinical and laboratory indices of disease activity. Treatment had n o noticeable effect on iridocyclitis. One patient died of cytomegalovi rus infection during azathioprine treatment. Conclusion. Azathioprine is a useful drug in severe JCA, with a sustained effect and acceptable side effects. Even in cases of incomplete remission, its glucocortico id sparing effect was noteworthy.