Joint effort for arthritic children
At first, ‘Secukinumab’ may sound like a magic incantation like Abracadabra or Shazam! Turns out, it’s actually a magic word doctors swear by to treat children suffering from any kind of joint pain. This may arise due to Enthesitis Related Arthritis (ERA), an autoimmune disorder wherein cells of your own body start attacking the others. The US Food and Drug Administration (FDA) has approved secukinumab, a type of drug known as a biological therapy, for the treatment of patients aged two years and older.
Doctors in India are now embracing the same. Interestingly, this is a monoclonal antibody treatment, which means an antibody made by cloning a unique white blood cell of the human body. In ERA, the body’s immune system gets confused and attacks the cells and tissues in the body’s connective tissues, including the joints, tendons and entheses. This leads to redness, swelling, pain, stiffness or loss of movement in these connective tissues, affecting the patient’s mobility.
“Secukinumab (pronounced sec-you-ki-new-mab) is an antibody that specifically targets and neutralises inflammatory cells in the body. The advantage of such specific targeted therapy is that it only affects the particular molecule that we desire to block, without affecting the body’s overall immunity. Blocking such cells halts the problem of swelling, thus reducing disease symptoms as well as preventing further joint damage,” explains Dr. Sakshi Mittal, Consultant Rheumatologist and Clinical Immunologist, Max Hospital, Gurgaon.
It is an injection that needs to be administered once a month. Administering this drug doesn’t require hospital admission. Furthermore, parents can be trained to administer the injection. It is currently available in India upon prescription by a specialist (dermatologist or rheumatologist). Experts opine that approval of Secukinumab injects new hope in the treatment of children with arthritis with a promise of pain-free and disability-free life.
Many would be surprised to know that psoriatic arthritis and ankylosing spondylitis, and enthesitis-related arthritis in children are also autoimmune disorders commonly seen in adults. But only up to 20 percent of cases may occur in children. If your child suffers from any of these, they will experience swelling, stiffness, severe pain of joints like hips, ankles or knees. Besides joint pain, children also often suffer from back or heel pain. These disorders can hamper a child’s growth and make them unable to remain active.
Many times psoriatic arthritis and ERA go unnoticed, which leads to disability, joint damage and other orthopaedic problems like tennis elbow. The connective tissue where tendons or ligaments attach to a bone is called enthesitis. The swelling or inflammation of the entheses is usually seen in late childhood or adolescence (eight to 15 years of age).
“About 10 percent of the patients with psoriasis, a skin disease, may develop pain and swelling of the joints and spine, called psoriatic arthritis. This type of arthritis may cause bony deformities over time. Patients with advanced psoriatic arthropathy may not be able to perform their routine activities on their own. Some children with psoriasis may have arthritis (joint pain, swelling or stiffness), even before the presence of skin disease,” says Dr. Abhishek Patil, Consultant, Rheumatology, Manipal Hospital, Old Airport Road, Bengaluru. He believes that early treatment of arthritis is a must to prevent disability and slowness of growth.
Secukinumab has already been in use for the treatment of psoriasis, psoriatic arthritis and ankylosing spondylitis in adults for the past few years. Now, it has also been approved for the treatment of ERA and psoriatic arthritis in children.
Experts believe that the best part of this therapy is that its success rate is higher than conventional medicines and one need not wait for a long time to see results. “The doctor generally switches to the biological therapy for psoriasis when the patient has already tried conventional medications and has not gotten better. Even in case of multiple side effects from the conventional drugs, biological therapy is preferred by doctors,” adds Patil. Not a hard pill to swallow.
Doctorspeak
✥ Physical activities like stretching, strengthening and aerobic activities are advisable for those suffering from arthritis
✥ MRI scan depicts not only the enthesis itself but also associated findings such as soft tissue involvement and bone marrow oedema
✥ Juvenile enthesitis-related arthritis includes swelling and pain in the region where tendons and ligaments attach to bone. It affects more boys than girls.
✥ Psoriasis is an autoimmune disorder that affects the skin. About 1 percent of the population suffers from the condition.
✥ An autoimmune disorder means that your own body’s immune system has turned against you and is out to attack your healthy cells.
Dr Abhishek Patil, Consultant, Rheumatology, Manipal Hospital Old Airport Road, Bengaluru