Vol.23 No.4

Original Article

Radiologic analysis of the effect of tocilizumab on hands and large joints in children with systemic juvenile idiopathic arthritis

Authors

Yutaka Inaba1 , Remi Ozawa2 , Chie Aoki1 , Tomoyuki Imagawa2 , Masaaki Mori2 , Ryoki Hara2 , Takako Miyamae2 , Tomoyuki Saito1 , Shumpei Yokota2

  • Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
  • Department of Pediatrics, Yokohama City University, Yokohama, Japan
Received:

14 March 2012

Accepted:

14 June 2012

Published online:

13 July 2012

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Abstract

Objectives To assess the efficacy of tocilizumab for preventing damage to the joints of systemic juvenile idiopathic arthritis (sJIA) patients, we examined serial radiographs of the hands and large weight-bearing joints of these patients before and after treatment with this agent.
Methods Nine patients with sJIA receiving 8 mg/kg of tocilizumab intravenously every 2 weeks were studied. The mean follow-up period was 82 months. The number of active joints and laboratory markers of inflammation were assessed before and after tocilizumab treatment, together with radiologic evaluation of the hips, knees, ankles, shoulders, and elbows. The latter examination included soft tissue swelling, juxta-articular osteoporosis, epiphyseal irregularity, joint-space narrowing, cyst formation, erosion, and localized growth abnormalities. Modified Larsen scores for the large joints and the Poznanski score were also recorded.
Results After tocilizumab treatment, the number of active joints and serum inflammatory markers decreased (p%ABST%.01). There was a decrease in radiologic abnormalities at the final follow-up (p%ABST%.01) with the exception of localized growth abnormalities. Radiologic improvement was observed in 47 joints (52 %), but ten (11 %) worsened.
Total Larsen score was decreased from 15.8 to 10.9 at the final follow-up. Although the Poznanski score did not change after tocilizumab treatment, it was closely correlated with the total Larsen score (r = 0.53, p%ABST%.05).
Conclusions We describe radiologic improvement of the majority of damaged large joints in sJIA following tocilizumab therapy, but some deteriorated further despite stabilization of systemic inflammatory responses. Further studies with a larger number of patients are needed.

Key words

Juvenile idiopathic arthritis, Larsen score, Pozanaski score, Systemic course, Tocilizumab