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Posted by on Aug 21, 2019 in Rheumatoid Arthritis | 0 comments

In a nutshell

This study investigated the use of leflunomide (Arava) in juvenile idiopathic arthritis (JIA).  

They found that this medication may be useful in managing JIA in patients resistant or intolerant to methotrexate

Some background

Juvenile idiopathic arthritis (JIA) is caused by inflammation in the joints. JIA is treated with drugs to reduce inflammation. These are called disease-modifying anti-rheumatic drugs (DMARDs). The aim of JIA treatment is to achieve low disease activity (LDA) or remission (no symptoms). Most patients with JIA are treated with a drug called methotrexate (MTX). MTX targets a number of pathways involved in inflammation. 

Some patients to do not respond to MTX. Other DMARDs including biologic drugs are sometimes prescribed instead. Leflunomide (LFN) is a DMARD that is licensed for use in JIA patients. It is unclear if LFN is safe and effective in JIA treatment. 

Methods & findings

This study included 38 JIA patients. The authors reviewed the medical records of these patients. JIA patients with LDA were treated with LFN due to lack of response to MTX. Disease activity (DA) was determined by measuring inflammatory markers. These included C-reactive protein (CRP) and rheumatoid factor (RF). 

36 patients were initially treated with MTX. 2 patients were treated with a DMARD called sulfasalazine (Azulfidine). MTX treatment was stopped due to bowel side effects. 13 of these patients had LDA and were switched to LFN. 6 patients in remission were treated with LFN when they had a relapse of symptoms. Patients with moderate and high DA were treated with biologic drugs after MTX withdrawal. LFN was added to biologic drugs if the response was not adequate. LDA was achieved in all patients at the last clinic visit.  

The bottom line

The authors concluded that LFN may be useful in managing JIA in patients unresponsive or intolerant to other DMARDs.

The fine print

The number of patients in this study was low. It was a retrospective study, meaning it looked back at medical records. Therefore, some patient data is missing. More investigation is needed. 

What’s next?

If you have any concerns regarding JIA management, please consult with your doctor. 

Published By :

Rheumatology International

Date :

Jul 20, 2019

Original Title :

Leflunomide treatment in juvenile idiopathic arthritis.

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