Objective-To study the eYcacy 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 cyclosporin 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 immediate significant decrease in joint pain (p<0.05), disappearance of morning stiVness, and regression of joint swelling (p<0.05) were observed. Improvement was apparent after two injections. An immediate significant (p<0.05) decrease in erythrocyte sedimentation rate, C reactive protein, and interleukin 6 was observed. Side eVects consisted of mild reactions at the injection site in two children. Conclusions-In this observational study, etanercept in combination with methotrexate was well tolerated and highly eVective in treating juvenile polyarthritis but not in the patient with systemic arthritis. Combination treatment appears to be feasible in terms of toxicity and may enhance eYciency. (Ann Rheum Dis 2001;60:410-412) The term juvenile idiopathic arthritis (JIA) was coined in 1996 and includes juvenile rheumatoid and chronic arthritis according to the earlier ARA and EULAR classification criteria.
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