Özet:

Aim: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of childhood. Disease-modifying antirheumatic drugs (DMARD) such as methotrexate (MTX), leflunomide (LFN) are first-line treatment in JIA. MTX is the most commonly prescribed drug. Studies predominantly demonstrate the efficacy and safety of it, but the data on LFN are limited. This study aimed to present our experience with LFN treatment in JIA patients. Materials and Methods: This retrospective study included JIA patients who were followed-up regularly and had received LFN. Data on patient demographics, clinical and laboratory characteristics were obtained from medical charts. Results: The study included 18 patients (15 female and 3 male) with a median (interquartile range) age at onset of disease 7.3 (3.1-12.0) years. Among them, 8 had oligoarticular JIA, seven had polyarticular JIA, two had systemic JIA and one had enthesitis-related arthritis (ERA). All patients received MTX as initial therapy (except one patient diagnosed with ERA was treated with sulfasalazine). MTX was discontinued and LFN treatment was started in all patients who initially received MTX due to gastrointestinal system (GIS) intolerance. Six of 7 patients with low disease activity, who had GIS intolerance while taking MTX before, were given LFN treatment because the disease activity was low. These patients achieved a complete remission with LFN. Four patients followed in remission with MTX had disease activation. These patients, who had previously experienced MTX intolerance, were given LFN treatment. Remission was achieved with LFN in 3 of 4 patients. Biological therapy was started in 6 patients with moderate or high disease activity who could not achieve remission with only MTX. These patients who did not have an adequate response were swicthed to LFN. Inactive disease was obtained in only 1 patient with the combination of LFN and biological agent. The patient with ERA was switched to LFN treatment due to inadequate response to sulfasalazine treatment. This patient achieved a complete remission with LFN. Conclusions: LFN therapy may be beneficial in patients with low disease activity and/ or remission with other DMARDs and relapse after drug discontinuation.

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