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Chapter 3.1. Efficiency and safety infliksimaba at children with JUIA.

The efficiency and safety estimation infliksimaba was spent at 30 children with juvenilnym an idiopathic arthritis. From them 20 children (66,7 %) with system variant JUIA and 10 (33,3 %) with the articulate.

The big share of children with system variant JUIA is caused by that infliksimab within several years was only thing GIBP registered in territory of the Russian Federation, officially has not been resolved for use at children, prescribed in pediatric practice under vital indications. All children who have entered into group, were with the long experience of disease, torpid current JUIA against massive antirheumatic therapy by two and more preparations.

SYSTEM VARIANT JUIA:

In a subgroup of children with system variant JUIA (20 children: 13 girls, 7 boys) middle age has made 10,3 yo 3,2 (10) (from 5 till 16 years), the disease debut fell 3,8 yo 3,0 (2,5), average duration of disease before appointment infliksimaba - 7,0 yo to 2,6 (6,8) years (Table 3.1.1). Extraarticular implications JUIA, such as a fever, a lymphadenopathy, gepatosplenomegalija, a leukocytosis - 16,4 2,8 (15,9) h109/l, a thrombocytosis - 624 yo 171 (635) h109/l were observed at all 20 (100 %) children in a debut and-or in height of disease, an eruption - at 11 (55 %) children, a carditis - at 7 (35 %).

Table 3.1.1 the General characteristic of the patients included in group infliksimaba with system variant JUIA.

Demographic indicators System variant JUIA, М8 (Me)
Quantity of patients (N) 20
Girls/boys 13/7 (1,9:1)
Middle age, in years 10,3 yo 3,2 (10)
Age of the beginning of disease, in years 3,8 yo 3,0 (2,5)
Duration of disease, in years 7,0 yo 2,6 (6,8)
Therapy in the anamnesis
GK per os 15 (75 %)

Pulse-therapy by Methylprednisolonum 20 (100 %)
v/s injections GK 20 (100 %)
MHT 20 (100 %)
МХТ+ЦиА 18 (90 %)
MHT + leflunomid 8 (40 %)
MHT + SSZ 5 (20 %)
GIBP -
Therapy by the appointment moment infliksimaba
МХТ+метилпреднизолон per os 2 (10,0 %)
Wood lunomid 1 (5,0 %)
Wood lunomid +метилпреднизолон per os 3 (15,0 %)
МХТ+ЦИА 3 (15 %)
МХТ+ЦиА + Methylprednisolonum per os 5 (25,0 %)
МХТ+лефлуномид+метилпреднизолон

per os

4 (20,0 %)
МХТ+ЦИА+ССЗ 1 (5,0 %)
SSZ + Methylprednisolonum per os 1 (5,0 %)
Indicators of activity JUIA by the appointment moment infliksimaba
ESR, mm/ch 44,5 yo 18 (45)
SRB, mg/dl 10,1 yo 8,6 (8)
Kol-in active joints (N) 20,5 yo 7,2 (21)
Kol-in joints with function restriction (N) 22,1 yo 6,6 (21,5)
YOURS of the doctor, points (0-100) 94 yo 5,7 (100)
YOURS of the patient, points (0-100) 85,613,2 (98)
CHAQ, points (0-3) 2,4 yo 0,6 (2,5)

By the moment of appointment of therapy infliksimabom at all patients the lymphadenopathy, gepatosplenomegalija, a leukocytosis - 14,3 yo 3,7 (14,6) h109/l, a thrombocytosis - 575 yo 167 (556) h109/l remained, at 8 (40 %) children incidentally became perceptible a fervescence to subfebrile digits, at a two (10 %) children - eruption occurrence on a skin, at 4 (20 %) - a carditis.

In a disease debut proof the joint syndrome was observed at 16 (80 %) children. Thus, at 14 from them, the polyarthritis, and only at two children - oligoartrit at once was generated. At other 4 patients (25 %) in a disease debut flying arthralgias were observed, and proof the joint syndrome was generated by 3-18 months from the disease beginning.

By the appointment moment infliksimaba the quantity of active joints in a subgroup of children with system variant JUIA has made 20,5 yo 7,2 (21), joints with function restriction - 22,1 yo 6,6 (21,5).

Children with a high (3) degree of activity of disease prevailed, only the five (25 %) children had a second degree of activity. ESR level on the average made 44,5 yo 18 (45) mm/ch, SRB - 10,1 yo 8,6 (8) mg/dl (at norm - 0,8mg/dl). Also at children rising of levels of immunoglobulins And - 470 yo 168 (462) mg/dl (norm of 60-250 mg/dl), immunoglobuinov M - 205 yo 133 (208) mg/dl (norm of 50-180 mg/dl), immunoglobulins G - 1687 yo 801 (1640) mg/dl (norm 5401600 mg/dl), an anaemia (a haemoglobin average level in blood - 106 yo 17 mg/dl) became perceptible.

All patients before appointment infliksimaba received massive basic immunosupressivnuju therapy by two and more preparations. By the appointment moment infliksimaba, 15 (75 %) children received GK per osв to an average dosage on Prednisolonum 6,2 yo 3,6 (6,0) mg a day (0,1-0,3 mg/kg/sut) in a combination with other standard antirheumatic preparations. (Table 3.1.1)

The general estimation the doctor of activity of illness on YOURS before initsiatsiej infliksimabom made 94 yo 5,7 (100) points, the estimation the patient or his parent was hardly more low - 85,9 yo 13,2 (98).

Functional insufficiency of patients by criteria CHAQ before appointment infliksimaba has on the average made 2,4 yo 0,6 (2,5) points, that on classification Dempster and co-authors there corresponds to serious functional disturbances (Table 3.1.1)

EFFICIENCY INFLIKSIMABA AT CHILDREN WITH SYSTEM VARIANT JUIA:

By results of research, by 3rd months from the beginning of therapy at children with system variant JUIA it was possible to stop such extraarticular implications JUIA as a carditis, an eruption, gepatosplenomegaliju, the body temperature was normalised. The quantity of active joints has decreased with 20,5 yo 7,2 (21) to 11,6 yo 6,6 (12,5) (р=0,001). The quantity of joints about function restriction remains
Without dynamics also has made 21,6 yo 8,8 (20,5), that can speak the generated rasping changes in joints against a serious long current of disease before appointment infliksimaba, prevalence III-IV of a radiological stage of disease at overwhelming number of patients before initsiatsiej infliksimabom. (The Drawing 3.1.1, table 3.1.3)

Drawing № 3.1.1 Dynamics of quantity of active joints from joints with restriction of function at children with system variant JUIA against therapy infliksimabom.

By three months from the therapy beginning appreciable depression of humoral activity of disease is received: an ESR has decreased with 44,5 yo 18,0 (45) mm/ch to 24,0 18,4 (19) (r = 0,001), SRB - with 10,1 yo 8,6 (8) to 3,4 yo 2,7 (3,5) mg/dl (r = 0,001). The quantity of leucocytes has decreased to 11, 6 yo 4,8 (10,8) h109/l (to therapy 14,3 yo 3,7 (14,6) h109/l, thrombocytes to 490 yo 178 (482) h109/l (before therapy 575 yo 167 (556) h109/l. Also at children normalisation of levels of immunoglobulins And - 198 yo 99,4 (195) mg/dl, immunoglobuinov M-165 yo 49,0 (155,5) mg/dl, immunoglobulins G - 1250 yo 450 (1150) mg/dl, rising of level of haemoglobin of blood - 115 yo 18 (117) mg/dl is noted. (A drawing 3.1.2, Table 3.1.3)


Drawing № 3.1.2 Dynamics of indicators of an ESR and SRB at children with the system

Variant JUIA against therapy infliksimabom.

The general estimation the doctor of activity of illness on YOURS has decreased to 62,4 yo 21,0 (58) points (r = 0,001) an estimation the patient or his parents - to 56,7 yo 18,3 (60) points (р=0,001). Functional insufficiency of patients in 3 months from the therapy beginning has made 1,8 yo 1,1 (1,5) points (р=0,039) (Table 3.1.3, a drawing 3).

Drawing № 3.1.3 Dynamics of indicators of a visual analogue scale (YOURS) of doctors and patients (and-or their parents) with system variant JUIA against therapy infliksimabom.


Drawing № 3.1.4 Dynamics CHAQ at children with system variant JUIA against therapy infliksimabom.

At a complex estimation of efficiency infliksimaba at children with system variant JUIA, later 3 months from the therapy beginning, ACR pedi-3 0 have been reached at 19 children (95,0 %), ACR pedi-50 - at 9 (45 %), ACR pedi-70 - at 4х (20 %), ACR pedi-80,90 - at 1 child (5 %). Therapy infliksimabom has appeared noneffective at one girl (5 %) (Table 3.1.4, a drawing 3.1.5). Further this child has left research in connection with developed expressed infusional reaction to the fifth introduction infliksimaba. For this reason to estimate efficiency in 6 months from the therapy beginning it was possible only at 19 children with system variant JUIA.

By 6 months in a studied subgroup of children small increase of quantity of active joints in comparison with the results received in three months from the beginning of therapy - 13,2 yo 9,1 (14) is noted. The quantity of joints with function restriction remains without essential dynamics 20,5 yo 7,2 (19,5).

Depression of humoral activity has been taped at 9 (47,4 %) from 19 children who have entered into research. 10 children humoral activity of disease remained with the others enough high. On the average the ESR indicator has decreased to 23,1 yo 19,5 (21) mm/ch (a drawing 2.3.2). Level SRB has decreased slightly, and has made in dynamics 4,3 yo 2,7 (4,5) mg/dl. The quantity of thrombocytes, leucocytes, immunoglobulins And and M, haemoglobin level remained without essential dynamics in comparison with results of 3 months. The average level of immunoglobulins G has reached the top border of norm and has made 1559 yo 710 mg/dl, that above trimensual results.


The general estimation the doctor and the patient of activity of illness on YOURS also remained without essential dynamics. Functional insufficiency of patients in 6 months from the therapy beginning has made 1,5 yo 1,2 points (1,5) (Table 3.1.3, a drawing 3).

At a complex estimation of efficiency infliksimaba, later 6 months from the therapy beginning, ACR pedi-30 will reach at 18 children (94,7 %), ACR pedi-50 - at 9 (47,4 %), ACR pedi-70 - at 2 (10,5 %). One patient (5,3 %) continued to remain "neotvetchikom" on spent therapy (the Drawing 3.1.5, Table 3.1.4).

Later 4 months from the therapy beginning, at one child are registered an urolithiasis exacerbation. For this reason therapy infliksimabom was the interval between introductions till 10 weeks, with the further continuation of the begun treatment is temporarily suspended, enlarged.

Later 9 months one more girl has left research in connection with therapy discontinuing. Participation in research has proceeded at 18 children. The special attention turns on itself occurrence of the tendency to depression of efficiency of spent therapy: to augmentation of quantity of active joints to 15,3 yo 8,7 (16) and joints with restriction of function to 21,1 yo 6,8 (21,5), to increase of humoral activity in comparison with results of six months of therapy - an ESR 30,2 yo 12,3 (28) mm/ch, SRB 5,2 yo 2,3 (5,5) mg/dl. YOU of the doctor was peer 71,5 yo 11,6 (70) points, YOURS of the patient - 64,4 yo 20,1 (65), CHAQ - 1,8 yo 0,6 (1,75).

At a complex estimation of efficiency infliksimaba later 9 months from the beginning of research ACR pedi-30 have been reached at all 18 patients (100 %), ACR pedi-50 - at 7 (38,9 %), ACR pedi-70 - at 4 (22,2 %). (The Drawing 3.1.5, Table 3.1.3).

For the purpose of rising of efficiency of therapy infliksimabom to children who have reached only 30 % by the answer on ACR pedi, escalation of a dose of a preparation about 3-5 mg/kg to 8-10 mg/kg on introduction has been spent.

By 12 months of research of essential dynamics by results of an efficiency estimation infliksimaba in comparison with results of 9 months it has not been received. The average quantity of active joints and joints with mobility restriction has made 14,9 yo 10,2 (15) and 20,8 yo 11,4 (18) accordingly (a drawing 3.1.1). The ESR Average index has made 29,4 yo 15,1 (25) mm/ch, quantity, SRB - 5,0 yo 4,9 (4,8) (a drawing 3.1.2). The quantity of thrombocytes, leucocytes, erythrocytes, immunoglobulins And, M, G remained without dynamics in comparison with results of 6 and 9 months. Small depression of level of haemoglobin to 109 yo 16 (105) mg/dl is noted.

Indicators YOURS the doctor have made 68,4 yo 17 (65), YOURS the patient and-or his parents - 65,1 yo 14,7 (67) points. Functional insufficiency of patients in 12 months from the therapy beginning has made 1,7 yo 0,55 (1,5) points.

At a complex estimation, later 12 months, in a subgroup of patients with system variant JUIA ACR pedi-30 remained at all children (100 %), ACR pedi-50 - at 7 (38,9 %), ACR pedi-70 - at 5 (27,8 %). At three children, by 12 months from the therapy beginning infliksimabom, in an average dosage of 5 mg/kg on introduction, development of medicamental clinico-laboratory remission is registered: at two children - ACR pedi-90, and at one girl - ACR pedi-100 (the Drawing 3.1.5, Table 3.1.3).

Despite dose escalation infliksimaba at a part the patient efficiency of therapy continued to decrease steadily (ACR pedi-30 and less), in connection with development secondary refrakternosti to a preparation. For this reason, in a year from the therapy beginning, two children have been translated on therapy totsillizumabom, two on therapy etanertseptom. One more girl from 70 % the answer to therapy infliksimabom, on reaching 18-year-old age has been translated under observation in other hospital and has left research.

By 18 months from the beginning of therapy efficiency ifliksimaba has been estimated at 13 children. By results of research at four children against dose escalation infliksimaba by one and a half years of application of a preparation it was possible to reach at least 50 % of the answer, and at a two from them of 80-90 % of the answer to therapy. In the general subgroup of children the quantity of active joints has on the average made 12,4 yo 6,8 (13), joints with function restriction - 20,1 yo 7,4 (18) (a drawing 1.3.2). As, depression of average indexes of an ESR to 22,6 yo 11,1 (20) mm/ch and SRB to 3,8 yo 0,6 (3,5) mg/dl is noted. (A drawing 2.3.2). The quantity of leucocytes, thrombocytes, immunoglobulins A, M, G, haemoglobin level were normalised. YOUR indicator of the doctor has made 65,3 yo 10,8 (68), YOURS the patient and-or parents - 54,8 yo 18,2 (55). The Average level of functional insufficiency has decreased to 1,5 yo 0,5 (1,4).

At one girl, from 30 % the answer to therapy infliksimabom by 12 months of therapy, in 18 months had been fixed an exacerbation of disease without system implications: narosli articulate a syndrome, humoral and immunologic activity. In this connection, further, the child has been translated on therapy abatatseptom with good effect.

At the others 12 children (92,3 %) have been received at least 30 % improvement by criteria ACR pedi. Answer ACR pedi-50 is received at 9 children (69,2 %), ACR pedi-70,80 - at 5 (38,5 %), By 18 months from the therapy beginning, at one child are fixed development of clinico-laboratory remission, in other 3 children from 90-100 % the answer received earlier, efficiency of therapy remained (ACR pedi-90 at 4 (30,8 %), ACR pedi-100 - at one (7,7 %) from them (the Drawing 3.1.5, Table 3.1.3).

Against therapy infliksimabom, by 12 months from the beginning of therapy, 7th children with system variant JUIA were possible manage completely GK per os.К to 18 months average dosage GK per osпо to Prednisolonum has decreased 6,2 yo 3,6 (6,0) mg a day to 3,08 yo 2,4 (2,9) mg a day. As, in 6 months from the beginning of therapy 2 children managed to cancel cyclosporine And, in 12 months, to one girl it is excellent leflunomid.

Adherence indicator to therapy infliksimabom at children with system variant JUIA after 3/6/9/12/18 months from the therapy beginning were peer 1/0,95/0,9/0,9/0,72 accordingly. Thus, value of indexes LUNDEX (to ACR pedi 50/70/80/90) for infliksimaba in 3 months from the therapy beginning were comparable to indicators ACR pedi. Indicators of indexes LUNDEX in 6, 12, 18 months are presented in the table № 3.1.2

The table № 3.1.2. Index LUNDEX at children with system variant JUIA against therapy infliksimabom.

I.Lundex 3 mes (n=20) 6 mes (n=19) 9 mes (n=18) 12 mes (n=18) 18 mes (n=13)
ACR pedi 0 0,05 0,5 - - 0,04
ACR pedi 30 0,95 0,9 0,9 0,9 0,66
ACR pedi 50 0,45 0,45 0,35 0,35 0,50
ACR pedi 70 0,20 0,1 0,2 0,25 0,28
ACR pedi 80 0,05 - - 0,15 0,28
ACR pedi 90 0,05 - - 0,15 0,22
ACR pedi 100 - - 0,22 0,05 0,04

Thus, by 18th month from the therapy beginning infliksimabom, considering adherence to therapy, only at half of children 50 % the answer by criteria ACR pedi have been reached at least. At the remained half of patients the answer to spent therapy that is obviously insufficient at treatment of a system variant of disease with high degree of clinico-laboratory activity has been received 30 percent and less. Attracts attention gradual depression of efficiency of therapy infliksimaba eventually in connection with development secondary refrakternosti. However, at escalation of a dose of a preparation to 8-10 mg/kg on introduction, in the course of observation, at a number of patients it was possible to enlarge efficiency of spent therapy infliksimabom.

The undesirable phenomena on preparation introduction infliksimab consisted in development of infusional reactions at 5 of 20 patients (20 %), in the form of vascular reactions, a cyanosis, difficulty of breath, a nausea, at one child 1 (5 %) are noted occurrence of allergic rashes on the first introductions of a preparation.

However the reason of cancellation of therapy infusional reaction became only at one child. In other cases the undesirable phenomena were quickly stopped by retardation of a rate of administering infliksimaba, intravenous introduction GK, appointment of antihistamine preparations.

Among other undesirable phenomena development of a primary tubercular complex with centre localisation in the top share of the left lung which has been taped at the patient on 3rd year of successful application infliksimaba became the most serious. After the termination of a course of antituberculous therapy the girl has been translated on therapy totsillizumabom.

At 2 sick (10 %), receiving therapy infliksimabom, the infection caused by virus Herpes zoster is fixed.

The table № 3.1.3 Comparative efficiency infliksimaba through 3, 6, 9,

12, 18 months from the beginning of therapy at children with system variant JUIA.

0 mes (n=20) Myob (Me) 3 mes (n=20) Myob (Me) 6 mes (n=19) Myob (Me) 9 mes (n=18) Myob (Me) 12 mes (n=18) Myob (Me) 18 mes (n=13) Myob (Me)
Kol-in the active 20,5 yo 7,2 11,6 yo 6,6 13,2 yo 9,1 15,3 yo 8,7 14,9 yo 10,2 12,4 yo 6,8
Joints (N) (21) (12,5) ** (14) ** (16) (15) (13) *
Kol-in joints with 22,1 yo 6,6 21,6 yo 8,8 20,5 yo 7,2 21,1 yo 6,8 20,8 yo 11,4 20,1 yo 7,4
TNFS (N) (21,5) (20,5) (19,5) (21,5) (18) (18)
44,5 yo 18 24 yo 18,4 23,1 yo 19,5 30,2 yo 12,3 29,4 yo 15,1 22,6 yo 11,1
ESR, mm/ch (45) (19) ** (21) ** (28) * (25) * (20) **
10,1 yo 8,6 3,4 yo 2,7 4,3 yo 2,7 5,2 yo 2,3 5,0 yo 4,9 3,8 yo 0,6
SRB, mg/dl (8) (3,5) ** (4,5) * (5,5) * (4,8) * (3,5) *
YOURS of the doctor, 94 yo 5,7 62,4 yo 21 63,1 yo 10,4 71,5 yo 11,6 68,4 yo 17 65,3 yo 10,8
Points (100) (58) ** (61) ** (70) ** (65) ** (68) **
YOURS of the patient and-or parents, 85,613,2 56,7 yo 18,3 58,2 yo 16,3 64,4 yo 20,1 65,1 yo 14,7 54,8 yo 18,2
Points (98) (60) ** (55) ** (65) ** (67) ** (55) **
2,4 yo 0,6 1,8 yo 1,1 1,5 yo 1,2 1,8 yo 0,6 1,7 yo 0,55 1,5 yo 0,5
CHAQ, points (2,5) (1,5) * (1,5) * (1,75) * (1,5) ** (1,4) *

** р=0,001, * r 0,05).

Clinical example: application Experience infliksimaba at the patient with system variant JUIA.

Patient V, 8 years, since September, 2006 is under observation in children's rheumatological unit UDKB of the First MGMU of I.M.Setchenov. The boy from 2 pregnancies, proceeding with discontinuing threat, an iron deficiency anaemia, a chronic pre-natal hypoxia of a foetus since 31 weeks gestatsii. Labours the first, physiological, on 3940неделе. Weight of the child at a birth - 3800гр., growth - 55см. Early psychomotor development on age. Since two months at the boy implications atopicheskogo a dermatitis, since a year a frequent relapsing obstructive bronchitis were observed, we threaten on development of a bronchial asthma. The child has transferred to 1 year and 3 months right-hand nizhnedolevuju a pneumonia. Frequent acute respiratory diseases (to 10 times a year) further became perceptible. It is inoculated on an individual calendar till 1 year of 3 months, further medotvod. The Mantoux test was spent annually - negative. Allergic reactions to Cefazolinum, Dimexidum - in the form of an urticaria, on Amikacinum - vomiting, a food allergy - an exacerbation atopicheskogo a dermatitis, a pollinosis. The hereditary anamnesis: at mother - a pollinosis, at the grandma on a maternal line - an arthritis of knee joints (not specified).

Anamnez morbi: a disease Debut in 1 year and 3 months (10.04г.) When without the taped provoking factors at the boy within two weeks liftings of a body temperature to febrile digits, mainly in the morning, the expressed arthralgias, mobility restriction in humeral, ulnar and ankle joints, enanthesises became perceptible. At hospitalisation in a hospital on a residence the diagnosis has been made: Right-hand nizhnedolevaja a pneumonia. A reactive arthritis. JUIA? At survey attracted attention arthritises humeral, ulnar and ankle joints, a lymphadenopathy, it is spotty-papuleznaja an eruption on a skin without an itch at fever height, gepato - a splenomegaly. In analyses of blood at the child rising of levels of an ESR to 54 mm/ch, SRB, a leukocytosis, a thrombocytosis, an anaemia, positive ANF has been taped. To the boy massive antibacterial therapy, pulse-therapy by Methylprednisolonum, NPVP has been spent, Prednisolonum in a dosage of 0,5 mg/kg/days has been inside prescribed Against treatment the condition of the boy was normalised, however, at attempt to lower Prednisolonum dose exacerbations zabolevaniija became perceptible. Since January 2005года to therapy cyclosporine And, in September because of an inefficiency has been added
It is replaced on mikofenolata mofetil, however, expected improvement it has not been received. Disease has accepted continuously - relapsing, hormonedependent character of a current.

In our unit it is observed since September, 2006. At entering the condition of the boy was serious. The expressed intoxication, a febrile fever, the phenomena of a pleuritis, a pericarditis, gepato - splenomegalies, lymphadenopathies, an arthritis of cervical department of a backbone, humeral, ulnar, radiocarpal, coxofemoral, knee, the ankle joints, the expressed medicamental Icenco-Cushing syndrome, a delay of physical development, appreciable retardation of linear growth (96 sm in 6 years) was observed. By results of laboratory research in blood the expressed leukocytosis, a thrombocytosis, acceleration of an ESR to 61 mm/ch, rising of level SRB became perceptible. Convincing data for bacteriemic and-or virus infections it has not been received. According to a X-ray inspection the expressed osteoporosis, an illegibility of articulate surfaces, individual erosions of heads of femurs became perceptible, it is more at the left. Diagnosis JUIA, system variant, seronegative on the Russian Federation, activity of III item, Rg 2 items, NF 2А-2Б have been made to the boy. The massive antirheumatic therapy including pulse-therapy by Methylprednisolonum, introduction VVIG, Methotrexatum of 10 mg/m2, cyclosporine And, Prednisolonum (0,4 mg/kg/sut), NPVP, calcium preparations was spent. Against therapy the condition improved, however, after an extract, time in 3-5 months became perceptible repeated exacerbations of a basic disease.

In connection with a serious current of disease, torpid to standard massive protivorevtaticheskoj therapies, with 22.10.2009г. To the boy of 6 mg/kg have been prescribed to introduction under the standard scheme infliksimab in a dose. Before preparation appointment, the permission of local ethical committee has been received. The decision on appointment infliksimaba was accepted by a consultation, with participation of the principal of hospital. Parents signed the voluntary informed consent. Already after the first introductions of a preparation the condition of the boy has considerably improved: the body temperature was normalised, arthralgias, arthritis implications have decreased, depression of humoral activity, the maximum value of an ESR of 31 mm/ch is noted. By three months it was possible to reach 50 % of improvement on criteria ACR pedi. However, at first five introductions of a preparation, at the boy infusional reactions in the form of difficulty of breath, a dermahemia, a nausea became perceptible. The given reactions were stopped at retardation of rate of intravenous introduction of a preparation. At the subsequent introductions of infusional reactions it has not been noted. By nine months of therapy the boy managed to lower a dose of Prednisolonum to 0,1 mg/kg/sut, naros movement volume in coxofemoral, knee joints, cervical department of a backbone, humoral activity of disease (an ESR of 22-17 mm/ch has considerably decreased. SRB in norm), extraarticular implications did not recur (ACR pedi 70). By a year of therapy the boy managed to cancel completely
Prednisolonum, cyclosporine And, therapy infliksimabom 6 mg/kg on introduction of times in 8 weeks and Methotrexatum of 10 mg/m2 is continued. At the child were completely stopped ostrovospalitelnye changes in joints, it is appreciable naros movement volume in them, humoral indicators of blood was normalised, basic disease exacerbations it did not become perceptible, positive dynamics on X-ray inspection data (a drawing 3) is noted. For a year of therapy the boy has grown on 10 sm (106 sm). By criteria ACR pedi 100 % improvement that corresponds to medicamental clinico-laboratory remission of disease (the drawing 3.1.15) have been received. Further, disease remission remained throughout all period of observation (within two years).

The conclusion: Despite received, by results of the dissertational work, given about insufficient efficiency infliksimaba at children with the system variant JUIA, the presented clinical case shows high efficiency of a preparation at the given concrete patient with a serious current system JUIA. From disease history it is visible, that the good answer to therapy infliksimabom has been received already after the first introductions of a preparation. Fast increase of efficiency of therapy further became perceptible. So, by a year from initsiatsii it was possible to reach proof clinico-laboratory remission of disease. The given clinical case proves necessity of the personified approach at choice GIBP for each concrete patient with JUIA.

Drawing № 3.1.11. Dynamics of an articulate syndrome at patient V, against therapy infliksimabom.


Drawing № 3.1.12. Dynamics of an ESR at patient V, against therapy infliksimabom.

Drawing № 3.1.13. Dynamics YOURS at patient V, against therapy infliksimabom.

Drawing № 3.1.14. Dynamics CHAQ at patient V, against therapy infliksimabom.

Drawing № 3.1.15. ACR pedi at patient V, against therapy infliksimabom.


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Scientific source Loskutova Olga Jurevna. Efficiency and safety of genno-engineering biological preparations (infliksimab, etanertsept, abatatsept) at children with various variants juvenilnogo an idiopathic arthritis. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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  8. Chapter 2 the MATERIAL And RESEARCH METHODS
  9. CHAPTER 4. ACTIVE PRIMARY GERPESVIRUSNAJA THE INFECTION AT CHILDREN WITH THE LONG SUBFEBRILE CONDITION
  10. Loskutova Olga Jurevna. Efficiency and safety of genno-engineering biological preparations (infliksimab, etanertsept, abatatsept) at children with various variants juvenilnogo an idiopathic arthritis. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014, 2014
  11. THE TABLE OF CONTENTS