Analysis of the state of immunity in patients with jia in treatment

Abstract

The correct indication for suspending treatment with DMARDs (FAMES) and biological therapy in pediatric patients with mild infectious diseases or during vaccination is a common dilemma in pediatric rheumatology. In patients with juvenile idiopathic arthritis (JIA), clinical reactivations—both joint and extra-articular—are frequently observed during these treatment “pauses,” yet there is a lack of sufficient studies in the pediatric population to clarify the impact of these treatments on the immune system and thus justify this clinical approach. The objective of this study was to analyze the levels of T, B, and NK lymphocyte subpopulations in JIA patients treated with DMARDs and biological therapy. A descriptive, cross-sectional study was conducted involving 39 patients from the Pediatric Rheumatology Unit of the Reina Sofía University Hospital, all diagnosed with JIA according to the ILAR 2001 criteria. Patients were categorized into four groups: 8 in clinical remission without treatment, 17 receiving DMARD monotherapy, 7 on biological monotherapy, and 7 receiving combination DMARD-biological therapy. Patients with systemic JIA were excluded due to their distinct pathogenic mechanisms. Immune profiling was performed by flow cytometry to measure CD3, CD4, CD8, and CD19 cell levels (acquired immunity), NK cells (innate immunity), and the CD4/CD8 index.