J Clin Pediatr Vol.29 No.6 Jun TNF-α, JIA, JIA JIA JIA JIA JIA JIA. 50 mg ESR CRP JIA. Wallace [12]

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1 doi: / j.issn α(tnf-α) 1.2 ( ) TNF-α 1 ; 2 TNF-α ; 3 (RA) (AS) ; 4 ; 5 ; (Ps) 6 ; 7 (JIA) [1-6] 1.3 JIA JIA 0.8 mg / (kg ) 1 ~ 2 : mg / kg 3 JIA 1 JIA 0.8 mg/kg JIA 1 [78] JIA 2 [9] JIA 50 mg 1.4 JIA (MRI X ) (ILAR)2001 JIA [ ( ESR) C [ JIA JIA (RF) (CRP) RF CCP ] JIA RF JIA JIA JIA] 4 ~ 18 2 ~ 4 ACR [ACR Pedi 30 / 50 / 70]) [10] 6 : (MTX) 10 ~ 15 mg / m 2 ( (CHAQ) ) 1 12 ( ) 5 / ; 0.25 mg / (kg d)] % [ 30% ( ACR Pedi 30 ) : 6 30% 5 3 / DAS28 [11] RF ( CCP ) JIA ( ) ( ) JIA ( ESR CRP : 3 30% Wallace [12] JIA (ID) (CRM) JIA (CR) (ERA) ( ) (RF ) JIA JIA JIA(SoJIA) JIA : 1 MTX (

2 ); 2 EBV CMV JIA JIA ; 3 ; 4ESR CRP ; 5 [20] ( 1 ~ 8 ) ID 6 CRM CR 10% ~36% ID 12 1% ~ 6% ID TNF JIA X 1 TNF JIA ( ) JIA TNF [13] T-Spot 3 3 PPD ACR Pedi 30 ; 6 ACR Pedi 30 : ; 2 EBV CMV HBsAg HBV TNF ) ; 3 ; 2 JIA (ALT AST 2 ( ); DMARDs DMARDs JIA ( JIA 3 ~ 6 1 X ); 6 MTX 12 ACR Pedi 70 (62%) JIA (45%) [14] ~ 6 1 X : X X ( CT ) PPD HBV / HCV (HCV) JIA TNF ( ) [ ] [19] (HBV) JIA 2 ; 4 ; 5 TNF ; 7 6 ~ HBV (HBsAg) 2 HBV TNF 2.1 [ 21] HBV HBV JIA HCV HBV (IFN) : 1 28% ~ 39% [1516] HBV HCV ; 2 T ; 3HBsAg HBV (ALT AST ) ; 4HBsAg TNF-α HBV ; 5HBsAg HBV ; 6

3 589 HBsAg 1 10 TNF HBV DNA TNF TNF JIA [ ] TNF [1826] TNF JIA : 2.3 [ ] TNF TNF DNA [ ] TNF (FDA) TNF TNF 48 TNF [24] [33] 20 α (IFN-α) TNF-α (JIA 15 3 TNF ) (IBD) ; ( 11 / 10 ) 5 ; 80% TNF 30 (1 ~ 7 ) 2.5 (MAS) 11 MAS ( ) 18 JIA TNF MAS [37] MAS 6 [ ] TNF MAS [25] 4 ~ 17 ( 0.02% 17 MRI 0.015%) ( 0.014%) 4 ~17 FDA [38] 0.01% % [25] FDA JIA 21 8 [141719] JIA 1 FDA TNF 2.7 TNF [2123] 3 TNF TNF ~ 4

4 rheumatoid arthritis: a secondary analysis of clinical trial data 3.2 from children with polyarticular-course juvenile idiopathic arthritis [J]. Arthritis Rheum200960(12): TNF [12] Wallace CA Ruperto N Giannini E. Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis [J]. J Rheumatol200431(11): [13] Nielsen S Ruperto N Gerloni V et al. Preliminary evidence that etanercept may reduce radiographic progression in juvenile idiopathic arthritis [J ]. Clin Exp Rheumatol (4 ) : [14] Horneff G De Bock F Foeldvari I et al. Safety and efficacy of 4 combination of etanercept and methotrexate compared to TNF-α Registry [J] Ann Rheum Dis200968(4): [15] Lovell DJ Giannini EH Reiff A et al. Etanercept in children with polyarticular juvenile rheumatoid arthritis. Pediatric Rheumatology Collaborative Study Group [J]. N Engl J Med (11): : treatment with etanercept only in patients with juvenile idiopathic arthritis (JIA): preliminary data from the German JIA [16] Quartier P Taupin P Bourdeaut F et al. Efficacy of etanercept for the treatment of juvenile idiopathic arthritis according to the [1]. [J]. onset type [J]. Arthritis Rheum200348(4): (04): [17] Prince FH Twilt M ten Cate R et al. Long-term follow-up on [2]. effectiveness and safety of etanercept in juvenile idiopathic TNF-α IL-1β [J]. arthritis: the Dutch national register [J]. Ann Rheum Dis 20079(10): (5): [3]. [18] Gerloni V Pontikaki I Gattinara M et al. Focus on adverse [J] (5): events of tumour necrosis factor alpha blockade in juvenile [4]. - idiopathic arthritis in an open monocentric long-term prospective study of 163 patients [J ]. Ann Rheum Dis (8 ) : [J] (10): [5]. - [19] Lovell DJ Reiff A Ilowite NT et al. Safety and efficacy of up + to eight years of continuous etanercept therapy in patients with [J] (34): juvenile rheumatoid arthritis [J]. Arthritis Rheum200858(5): [6] [J] [20] Giannini EH Ilowite NT Lovell DJ et al. Long-term safety and 29(1): effectiveness of etanercept in children with selected categories of [7] Kuemmerle-Deschner JB Horneff G. Safety and efficacy of onceweekly juvenile idiopathic arthritis [J]. Arthritis Rheum (9): application of etanercept in children with juvenile idiopathic arthritis [J]. Rheumatol Int200728(2): [21] Zingarelli S Frassi M Bazzani C et al. Use of tumor necrosis [8] Horneff G Ebert A Fitter S et al. Safety and efficacy of once factor-alpha-blocking agents in hepatitis B virus-positive weekly etanercept 0.8 mg / kg in a multicentre 12 week trial in patients: reports of 3 cases and review of the literature [J]. J active polyarticular course juvenile idiopathic arthritis [ J ]. Rheumatol200936(6): Rheumatology (Oxford)200948(8): [22] Horneff G Schmeling H Biedermann T et al. The German [9] Yim DS Zhou H Buckwalter M et al. Population pharmacokinetic etanercept registry for treatment of juvenile idiopathic arthritis analysis and simulation of the time-concentration [J]. Ann Rheum Dis200463(12): profile of etanercept in pediatric patients with juvenile [23] Lovell DJ Ruperto N Goodman S et al. Adalimumab with or rheumatoid arthritis [ J ]. J Clin Pharmacol ( 3 ) : without methotrexate in juvenile rheumatoid arthritis [J]. N Engl J Med (8): [10] Giannini EH Ruperto N Ravelli A et al. Preliminary definition [24] Diak P Siegel J La Grenade L et al. Tumor necrosis factor of improvement in juvenile arthritis [J]. Arthritis Rheum1997 alpha blockers and malignancy in children: forty-eight cases 40(7): reported to the Food and Drug Administration [J]. Arthritis [11] Ringold S Chon Y Singer NG. Associations between the Rheum201062(8): American College of Rheumatology pediatric response measures [25] McCroskery P Wallace CA Lovell DJ et al. Summary of and the continuous measures of disease activity used in adult worldwide pediatric malignancies reported after exposure to

5 591 etanercept [J]. Pediatr Rheumatol Online J20108:18. [26] Kanakoudi-Tsakalidou F Tzimouli V Pratsidou-Gertsi P et al. The significance of persistent newly developed autoan-tibodies in JIA patients under long-term anti-tnf treatment [J]. Cytokine (3): [27] Bout-Tabaku S Rivas-Chacon R Restrepo R. Systemic lupus erythematosus in a patient treated with etanercept for polyarticular juvenile rheumatoid arthritis [J]. J Rheumatol (12): [28] Lepore L Marchetti F Facchini S et al. Drug-induced systemic lupus erythematosus associated with etanercept therapy in a child with juvenile idiopathic arthritis [J]. Clin Exp Rheumatol200321(2): [29] Fathalla BM Goldsmith DP Pascasio JM et al. Development of autoimmune hepatitis in a child with systemic-onset juvenile idiopathic arthritis during therapy with etanercept [J]. J Clin Rheumatol200814(5): [30] Livermore PA Murray KJ. Anti-tumour necrosis factor therapy associated with cutaneous vasculitis [J]. Rheumatology (Oxford) (12): [31] Hashkes PJ Shajrawi I. Sarcoid-related uveitis occurring during etanercept therapy [J ]. Clin Exp Rheumatol (5 ) : [32] Peek R Scott-Jupp R Strike H et al. Psoriasis after treatment of juvenile idiopathic arthritis with etanercept [J]. Dis200665(9):1259. Ann Rheum [33]. -α [J]. 2007(2): [34] Makay B Yilmaz S Turkyilmaz Z et al. Etanercept for therapy-resistant macrophage activation syndrome [J]. Pediatr Blood Cancer200850(2): [35] Lahdenne P V 覿 h 覿 salo P Honkanen V. Infliximab or etanercept in the treatment of children with refractory juvenile idiopathic arthritis: an open label study [J]. Ann Rheum Dis (3): [36] Kimura Y Pinho P Walco G et al. Etanercept treatment in patients with refractory systemic onset juvenile rheumatoid arthritis [J]. J Rheumatol200532(5): [37] Ramanan AV Schneider R. Macrophage activation syndrome following initiation of etanercept in a child with systemic onset juvenile rheumatoid arthritis [J]. J Rheumatol (2): [38] Mohan N Edwards ET Cupps TR et al. Demyelination occurring during anti-tumor necrosis factor alpha therapy for inflammatory arthritides [J]. Arthritis Rheum (12): ( ) : ( : )

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