A combination of etanercept and methotrexate for the treatment of refractory juvenile idiopathic arthritis: a pilot study

Objective-To study the efficacy of combination therapy with etanercept and methotrexate in patients with refractory juvenile idiopathic arthritis. Methods-Seven children with active juvenile idiopathic arthritis refractory to at least combination therapy with methotrexate and sulfasalazine or cyc losporin A were studied. Concomitant treatment, consisting of non-steroidal drugs, corticosteroids, and methotrexate, remained unchanged. Results-Six patients continued the treatment for at least 24 weeks. In the child with systemic arthritis, etanercept was stopped because of persisting spiking fever, joint pain, and rash. In the remaining children an immediat e significant decrease in joint pain (p<0.05), disappearance of morning sti ffness, and regression of joint swelling (p<0.05) were observed. Improvemen t was apparent after two injections. An immediate significant (p<0.05) decr ease in erythrocyte sedimentation rate, C reactive protein, and interleukin 6 was observed. Side effects consisted of mild reactions at the injection site in two children. Conclusions-In this observational study, etanercept in combination with met hotrexate was well tolerated and highly effective in treating juvenile poly arthritis but not in the patient with systemic arthritis. Combination treat ment appears to be feasible in terms of toxicity and may enhance efficiency .