Clinical rheumatology · 2026
The risk of neuropathy associated with biological therapy in juvenile idiopathic arthritis children.
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Hebeshi Nourhan Elsayed, Kassem Elham Mohammad, Hussein Manal Shawky, Elkholy Radwa Mostafa
Аннотация
OBJECTIVES: To evaluate the risk of neuropathy induced by biological drugs in children with juvenile idiopathic arthritis, clinically and by electrodiagnosis and ultrasonography.
PATIENTS AND METHODS: Eighty juvenile idiopathic arthritis (JIA) patients were divided into 2 groups: 40 patients under treatment of biologic drugs and conventional disease-modifying antirheumatic drugs (DMARDs) in group I for at least 6 months, and 40 patients under treatment of conventional DMARDs only in group II. Assessment was done using pediatric-modified total neuropathy score (Ped-mTNS), electrodiagnostic (EDX) tests, and nerve ultrasound.
RESULTS: There was a significant increase in Ped-mTNS, distal latency of peroneal nerve, and latency of tibial F wave and H-reflex, and a significant decrease in conduction velocity of both peroneal and tibial nerves in group I in comparison with group II. A positive correlation was detected between Ped-mTNS, cross-sectional area, and distal motor latency of the peroneal nerve, and between Ped-mTNS and tibial F wave latency, and a negative correlation between motor conduction velocity of the peroneal nerve and Ped-mTNS in group I. Absent H-reflex in 2 cases in group I.
CONCLUSIONS: Demyelinating peripheral neuropathy can represent a rare adverse event in JIA children treated with biological agents. Key Points • The potential risks associated with biological therapy in JIA patients and the importance of neuropathy screening in these patients. • Nerve ultrasound exhibits lower sensitivity compared to nerve conduction studies for detecting early or subclinical demyelination, as morphological changes may not be apparent on imaging despite measurable functional neurophysiological impairment. • Nerve ultrasound has a complementary role in the diagnosis of peripheral neuropathy, but clinical examination and electrodiagnostic testing remain the actual gold standard for the evaluation of the peripheral nervous system.
PATIENTS AND METHODS: Eighty juvenile idiopathic arthritis (JIA) patients were divided into 2 groups: 40 patients under treatment of biologic drugs and conventional disease-modifying antirheumatic drugs (DMARDs) in group I for at least 6 months, and 40 patients under treatment of conventional DMARDs only in group II. Assessment was done using pediatric-modified total neuropathy score (Ped-mTNS), electrodiagnostic (EDX) tests, and nerve ultrasound.
RESULTS: There was a significant increase in Ped-mTNS, distal latency of peroneal nerve, and latency of tibial F wave and H-reflex, and a significant decrease in conduction velocity of both peroneal and tibial nerves in group I in comparison with group II. A positive correlation was detected between Ped-mTNS, cross-sectional area, and distal motor latency of the peroneal nerve, and between Ped-mTNS and tibial F wave latency, and a negative correlation between motor conduction velocity of the peroneal nerve and Ped-mTNS in group I. Absent H-reflex in 2 cases in group I.
CONCLUSIONS: Demyelinating peripheral neuropathy can represent a rare adverse event in JIA children treated with biological agents. Key Points • The potential risks associated with biological therapy in JIA patients and the importance of neuropathy screening in these patients. • Nerve ultrasound exhibits lower sensitivity compared to nerve conduction studies for detecting early or subclinical demyelination, as morphological changes may not be apparent on imaging despite measurable functional neurophysiological impairment. • Nerve ultrasound has a complementary role in the diagnosis of peripheral neuropathy, but clinical examination and electrodiagnostic testing remain the actual gold standard for the evaluation of the peripheral nervous system.