The article presents the review of a safety of TNF blockers in treatment of rheumatologic diseases in adults and children. Authors give a data on separate, open-labeled, and multicenter double-blinded placebo-controlled studies of tolerance to infliximab, etanercept and adalimumab. The results of studies show high effectiveness and good safety of TNF blockers in adult’s and children’s rheumatologic practice. Key words: children, rheumatoid arthritis, juvenile arthritis, TNF blockers, treatment, safety, infliximab, adalimumab, etanercept.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(1):82-94)

An objective of this trial was evaluation of effect of treatment with blocker of tumor necrosis factor infliximab on dynamics of functional class and radiological changes of bone and cartilaginous tissue of joints in children with different clinical types of juvenile arthritis (JA). Infliximab was used according to standard scheme on 0, 2, 6 and then every 8 week by intravenous infusion. Mean single dose of infliximab was 6,8 ± 2,3 mg/kg. All children were treated with immunosuppressive agents (ciclosporin in 6% of patients, methotrexate in 60%, ciclosporin combined with methotrexate — 20%, ciclosporin with leflunomide — 5%, leflunomide with methotreate — 4%) combined with anti cytokine treatment. 7 children were treated with oral glucocorticoids in mean dose 0,37 mg/kg daily. disorders in joint function and structural changes of joints of different severity (radiological sign) were discovered in all patients before starting of treatment with infliximab. Duration of observation was 6 week — 2 years. Authors made a conclusion that treatment with infliximab prevents progressing of bone and cartilaginous destruction in all types of AJ, not depending on intensity of its clinical activity. This medication provides for full functional recovery of joints and elimination of features of disablement in patients with good clinical activity.Key words: children, juvenile arthritis, infliximab, treatment.

The overview is dedicated to the application of anti TNF medication to treat rheumatoid diseases among adults and children. The researchers provided for the data on the individual, open and multicentered, double, blind, placebobcontrolled research of infliximab, etanercept, adalimumab efficacy. The research findings witnessed high efficacy and safety of anti TNF therapy in both adult and children rheumatologic practice.Key words: infliximab, etanercept, adalimumab, children, treatment, juvenile rheumatoid arthritis, rheumatoid arthritis.

Juvenile rheumatoid arthritis (JRA) is chronic disease, leading to early incapacitating injury in patients. Treatment of JRA with new expensive biological agents allows obtaining long term remission of disease and improving its prognosis. Estimation of quality of life is one of the main effectiveness criteria of treatment. A quality of life in children who were 2–4 years old treated with infliximab was estimated. 43 patients with different types of JRA were examined. A quality of life was estimated with the help of questionnaire PEDSQL generic core scale, PEDSQL rheumatology module. Index of functional disability was estimated by childhood health assessment questionnaire (CHAQ). Significant increase of quality of life rates and decrease of index of functional disability was registered in 6 weeks of therapy with infliximab. The rates of quality of life in patients with JRA treated with infliximab were significantly equal to that in healthy children in the same age in 6, 12 and 24 months of treatment. Thus, treatment with infliximab significantly increases quality of life in children in 2–4 years old with JRA and their families, decreases negative influence of disease on child's living, improves physical activity and emotional state of patients, and allows improving contact between patients and healthy children in the same age.Key words: children, juvenile rheumatoid arthritis, quality of life, infliximab.

JUVENILE RHEUMATOID ARTHRITIS (JRA) IS CHRONIC DISEASE, LEADING TOEARLY INCAPACITATING INJURY IN PATIENTS. TREATMENT OF JRA WITH NEWEXPENSIVE BIOLOGICAL AGENTS ALLOWS OBTAINING LONGTERM REMISSIONOF DISEASE AND IMPROVING ITS PROGNOSIS. ESTIMATION OF QUALITY OFLIFE IS ONE OF THE MAIN EFFECTIVENESS CRITERIA OF TREATMENT. A QUALITYOF LIFE IN CHILDREN WHO WERE 2–4 YEARS OLD TREATED WITH INFLIXIMABWAS ESTIMATED. 43 PATIENTS WITH DIFFERENT TYPES OF JRA WEREEXAMINED. A QUALITY OF LIFE WAS ESTIMATED WITH THE HELP OF QUESTIONNAIRE PEDSQL GENERIC CORE SCALE, PEDSQL RHEUMATOLOGY MODULE.INDEX OF FUNCTIONAL DISABILITY WAS ESTIMATED BY CHILDHOOD HEALTHASSESSMENT QUESTIONNAIRE (CHAQ). SIGNIFICANT INCREASE OF QUALITYOF LIFE RATES AND DECREASE OF INDEX OF FUNCTIONAL DISABILITY WASREGISTERED IN 6 WEEKS OF THERAPY WITH INFLIXIMAB. THE RATES OF QUALITYOF LIFE IN PATIENTS WITH JRA TREATED WITH INFLIXIMAB WERE SIGNIFICANTLY EQUAL TO THAT IN HEALTHY CHILDREN IN THE SAME AGE IN 6, 12 AND24 MONTHS OF TREATMENT. THUS, TREATMENT WITH INFLIXIMAB SIGNIFICANTLY INCREASES QUALITY OF LIFE IN CHILDREN IN 2–4 YEARS OLD WITHJRA AND THEIR FAMILIES, DECREASES NEGATIVE INFLUENCE OF DISEASE ONCHILD'S LIVING, IMPROVES PHYSICAL ACTIVITY AND EMOTIONAL STATE OFPATIENTS, AND ALLOWS IMPROVING CONTACT BETWEEN PATIENTS ANDHEALTHY CHILDREN IN THE SAME AGE.KEY WORDS: CHILDREN, JUVENILE RHEUMATOID ARTHRITIS, QUALITYOF LIFE, INFLIXIMAB.

The study analyses efficiency and safety of using mono clone antibodies for tumor necrosis factor (infliximab) for children with system (n = 21) and articular (n = 59) juvenile arthritis (JA). Infliksimab was injected intravenously (average dose of 6,8 ± 2,3 mg/kg/per injection) by a standard scheme (0, 2, 6, and each 8 following weeks). Together with antibcytokine therapy children still received immunity depressants (cyclosporine, methotraksat, leflunomid, peroral glucocorticoids). Research results prove that infliximab has pronounced hormone like anti-inflammatory effect after first injection for both patients with early and delayed articular JA variants. It reserved articular syndrome, reduced laboratory activity parameters, reduced degree of invalidity, improved quality of patients' lives. At the same time after three first infusions 88% of patients with system JA the effect was neutralized, articular syndrome activity increased, laboratory activity parameters increased, systematic indicators recurred. On the contrary, patients with both early and delayed JA variant the medication quickly and efficiently reduced activity of articular syndrome, personal estimations of pain levels and disease activity. Index of life quality was significantly improved, much like the selfbservice ability. Medication effect was registered after the first injection and remained over the whole period of observation (up to two years) in 61% cases of delayed and 93% of early articular ja variant. Thus, infliximab therapy is a reasonable, efficient and safe treatment of patients with both early and delyed articular JA.Key words: juvenile arthritis, infliximab, treatment.

The purpose of this open study was to evaluate efficacy and safety of infliximab, an antiatnfa ?monoclonal antibody, in 37 children with juvenile idiopathic arthritis (JIA). Group 1 comprised 16 patients with severe longaterm jia with systemic onset. Group 2 comprised 21 patients with oligoa and polyarticular JIA. Groups were matched in demographic features. The follow up period has ranged between 6 weeks and 2 years. All children received infliximab and concomitant D mard therapy, 3 of them received oral glucocorticoids. Inflixa imab with a mean dose of 6,5 ± 0,3 mg/kg was administered intravenously at baseline, 2, 6 and every 8 week. Infliximab has shown statistically significant improvement (p < 0,01) in all patients with early oligoa and polyarticular JIA (group 2). Remission following the second infusion (at the 3 week of observation) has been registered in all patients with oligoa and polyarticular jia, meanwhile in patients with systemic JIA remission has been registered only in 2 cases at a time of 7 months of treatment with infliximab. Eight (50%) patients from group 1 and 2 children (9,5%) from group 2 discontinued infliximab due to inefficacy. 5 (24%) of patients from group 2 developed side effects that led to infliximab discontinuation. Therefore, the therapy with infliximab has proved to be sound, safe and effective with best results in patients with oligoa and polyarticular jia.Key words: juvenile rheumatoid arthritis, infliximab, children.