TITLE:
Thalidomide Is an Adjunct Therapy for the Refractory Systemic Juvenile Idiopathic Arthritis Patients in a Tertiary Hospital Study
AUTHORS:
Md. Taiyabur Rahman, Mujammel Haque, Farhana Faria, Mohammed Mahbubul Islam, Manik Kumar Talukder, Mohammad Imnul Islam, Shahana Akhter Rahman
KEYWORDS:
Juvenile Idiopathic Arthritis, Thalidomide, Refractory sJIA
JOURNAL NAME:
Open Journal of Rheumatology and Autoimmune Diseases,
Vol.13 No.2,
May
31,
2023
ABSTRACT: Background: Systemic JIA (sJIA) is one of the subtypes of JIA, which is most
difficult to treat among all JIA cases. About 50% of sJIA cases did not respond
to traditional disease modifying anti-rheumatic drugs (DMARDs)—metho-trexate (MTX). Thalidomide is
an immunomodulating and anti-inflammatory drug that induces sustained
improvement of refractory sJIA cases. Objectives: To evaluate the
efficacy of thalidomide in refractory sJIA patients. Methods: This was a
prospective interventional study carried out in the Paediatric Rheumatology and
Immunology follow-up clinic run by the Department of Pediatrics, Bangabandhu
Sheikh Mujib Medical University (BSMMU), Dhaka from January 2019 to July 2020.
Twenty-five sJIA patients who were refractory
to conventional DMARDs were included in this study. These patients were
prescribed thalidomide at a dose of 3 - 5 mg/kg/day for six months and efficacy was assessed by using juvenile
arthritis disease activity score (JADAS 27) at 12th and 24th weeks of treatment. Result: Active joint counts and ESR
improvement were observed in 90.69%, 97.67% and 69.84%, 100% of sJIA patients
respectively at 12th and 24th weeks of treatment.
Improvement of physicians and parent global assessment of VAS were 77.56%,
97.43% and 70.62% and 96.04% respectively at 12th and 24th weeks of treatment. Improvement of the total score of JADAS-27 was 77.51% at
12th week and 97.52% at 24th of week
follow-up which was statistically significant. Somnolence, constipation and
paresthesia were found as common adverse effect in this study. Conclusion: Efficacy of thalidomide was assessed by JADAS 27 criteria showed
significant improvement in refractory sJIA patients in this study. It may be
concluded that Thalidomide is safe and effective as an adjunct therapy of
refractory sJIA patients.