Suppression of fever and the acute-phase response in a patient with juvenile chronic arthritis treated with monoclonal antibody to tumour necrosis factor-alpha (cA2)

Br J Rheumatol. 1997 May;36(5):589-93. doi: 10.1093/rheumatology/36.5.589.


Juvenile chronic arthritis (JCA) is the commonest chronic rheumatic disorder of childhood. Although conventional therapy of JCA continues to improve, many patients experience long-term ill health as a result of their disease or treatment. In adult rheumatoid arthritis (RA), similar concerns have led to the development of therapies designed to interfere in key disease processes. One such therapy is cA2, a chimeric neutralizing monoclonal antibody to the inflammatory cytokine, tumour necrosis factor-alpha (TNF-alpha). The administration of cA2 in adult RA has led to impressive short-term suppression of disease, with a good safety profile. Here, we report the first use of cA2 in childhood arthritis, choosing a patient with severe systemic-onset JCA, resistant to conventional therapies. The patient received two i.v. infusions of cA2, each at a dose of 10 mg/kg, separated by 1 week. The treatment was well tolerated and induced rapid control of fever, anorexia and serositis, together with downregulation of interleukin (IL)-6, soluble TNF receptors (sTNFR) and IL-1ra, and the acute-phase proteins C-reactive protein (CRP) and serum amyloid A (SAA). In contrast, we saw no significant improvement in joint pain or tenderness. Our findings suggest that TNF-alpha is a mediator of fever and other systemic aspects of disease in systemic JCA. TNF-alpha blockade as a treatment modality in JCA deserves further study.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute-Phase Reaction / drug therapy*
  • Acute-Phase Reaction / physiopathology
  • Adolescent
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / immunology*
  • Antibodies, Monoclonal / therapeutic use*
  • Arthritis, Juvenile / blood
  • Arthritis, Juvenile / drug therapy*
  • Arthritis, Juvenile / physiopathology
  • Blood Sedimentation
  • Body Temperature / physiology
  • C-Reactive Protein / analysis
  • C-Reactive Protein / metabolism
  • Chronic Disease
  • Dose-Response Relationship, Drug
  • Female
  • Fever / drug therapy*
  • Fever / physiopathology
  • Humans
  • Ibuprofen / therapeutic use
  • Infliximab
  • Infusions, Intravenous
  • Interleukin-1 / blood
  • Joints / physiopathology
  • Prednisolone / therapeutic use
  • Serum Amyloid A Protein / analysis
  • Serum Amyloid A Protein / metabolism
  • Tumor Necrosis Factor-alpha / immunology*


  • Anti-Inflammatory Agents, Non-Steroidal
  • Antibodies, Monoclonal
  • Interleukin-1
  • Serum Amyloid A Protein
  • Tumor Necrosis Factor-alpha
  • C-Reactive Protein
  • Prednisolone
  • Infliximab
  • Ibuprofen