RESUMEN
OBJECTIVE: To investigate the rate of radiographic progression, as measured with the carpo-metacarpal ratio (Poznanski score), during etanercept (ETN) therapy in children with polyarticular juvenile idiopathic arthritis (JIA). METHODS: Patients included in the Italian ETN registry who had a standard radiograph of both hands and wrists in the posteroanterior view made at start of treatment and after 1 year were included in the study. The clinical response was assessed by means of the ACR Pediatric definition of improvement. Radiographic progression was determined by calculating the change in the Poznanski score between the baseline and the 1-year radiographs. RESULTS: A total of 40 patients were studied. The frequency of ACR pediatric 30, 50, and 70 response at 1 year was 77%, 72%, and 50%, respectively. The median change in the Poznanski score between baseline and 1 year was + 0.3 units, meaning that, on average, patients experienced improvement in radiographic progression. CONCLUSION: Our pilot study provides evidence that ETN is potentially capable of reducing the progression of radiographic joint damage in JIA. This finding deserves confirmation in a controlled trial.
Asunto(s)
Artritis Juvenil/diagnóstico por imagen , Artritis Juvenil/tratamiento farmacológico , Inmunoglobulina G/uso terapéutico , Inmunosupresores/uso terapéutico , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Sistema de Registros , Niño , Preescolar , Etanercept , Femenino , Humanos , Masculino , Huesos del Metacarpo/diagnóstico por imagen , Radiografía , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
The authors report 2 cases of herniated disc in subjects under 10 years of age. Spinal stiffness more than nerve root symptomatology is the dominant element in the clinical picture: the diagnosis was based on CT scan and on radiculography. In both cases surgical treatment resulted in resolution of the symptoms which was maintained in long-term follow-ups.