THE EXPERIENCE OF SWITCHING TO THE SECOND TNF INHIBITOR IN A PATIENT WITH SEVERE JUVENILE POLYARTHRITIS AND RESISTANCE TO THE FIRST TNF-BLOCKER

Abstract

The article presents a case of a severe progressive course of polyarticular juvenile idiopathic arthritis, debuting at an early age, refractory to the therapy with methotrexate, cyclosporine, and glucocorticosteroids. A clinical example demonstrates that switching to the second TNF inhibitor in the case of developing secondary resistance to the first drug from this group provides restoration of the therapeutic effect and is not accompanied by serious adverse events. Six months after switching to adalimumab, due to the «escape» of the effect of etanercept, the inflammatory changes in the patient were reversed; the volume of movements in the joints increased, and the laboratory parameters of the disease activity were normalized. After 1 year, there was a remission of the disease. The child managed to completely eliminate glucocorticosteroids for oral ingestion. The duration of the joint syndrome remission was 3 years. Adverse events were not serious and did not become a basis for drug withdrawal.

Keywords

• children
• juvenile idiopathic arthritis
• genetically engineered biological preparations
• adalimumab
• etanercept