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Background: Patients with juvenile idiopathic arthritis (JIA) may have lower protective levels of anti-vaccine antibodies due to high inflammatory activity, interrupted or incomplete vaccination schedule, and due to using of immune-modulating drugs, e.g. systemic corticosteroids (CS), methotrexate (MTX) and biologics.
Objectives: The aim of our study was to find the predictors of low levels of anti-vaccine antibodies in patients with JIA.
Methods: In the present study were included data 170 JIA (55 boys and 115 girls) aged from 2 to 17 years, who received scheduled vaccination before the age of 2 years and before JIA onset against measles, parotitis, hepatitis B, diphtheria and rubella. In all patients the Ig G anti-vaccine antibodies levels were detected with ELISA. In each patient we evaluate the type of the disease (oligoarthritis - 73, polyarthritis - 61, systemic-16 and enthesitis-related arthritis - 20), onset age, presence of uveitis, duration of JIA, treatment with corticosteroids (CS), methotrexate (MTX) and biologics. Data presented with median and 25%-75%.
Results: The main demographic characteristics: age of inclusion in the study 11.4 (7.6-14.8) years, disease onset – 6.0 (3.7-9.0) years, disease duration – 3.8 (1.9-6.5) years. Treatment with CS was in 43 (25.3%), MTX in 154 (90,6%) and biologics 82 (48.2%) patients, among them 53 had TNFa-inhibitors. More than 1 biologic consequently received 16/82 (19.5%) patients. Protective levels of anti-measles antibodies was in 98 (57,6%) of all JIA population, anti-parotitis – 136 (80.0%), anti-hepatitis B – 85 (50.0%), anti-diphtheria – 88 (51,7%), anti-rubella – 167 (98.8%). Data of vaccination status and anti-vaccine antibodies levels in the table. In univariate and multivariate regression analysis the main risk factors for anti-measles antibodies levels were MTX using (p=0.045), more than 1 biologics (p=0.0004); for anti-hepatitis B – MTX (p=0.03), for anti-diphtheria antibodies: onset age (p=0.0002), JIA duration (p=0.00007), number vaccine doses (p=0.02), more than 1 biologics (p=0.01); combined treatment with biologics and other drugs (MTX or CS).
| Parameter | No treatment (n=14) | MTT, only
| Biologics±MTT
| P |
|---|---|---|---|---|
| # anti-measels vaccine doses | 2.0 (2.0; 2.0) | 2.0 (1.0; 2.0) | 2.0 (1.0; 2.0) | 0.19 |
| Anti-measels IgG, Me/ml | 0.28 (0.1; 0.6) | 0.4 (0.1-0.7) | 0.17 (0.0; 0.29) | 0.0002 |
| Protective anti-measels IgG level, n (%) | 8 (57) | 50 (68) | 40 (49) | 0.06 |
| # anti-parotitis vaccine doses | 2.0 (2.0; 2.0) | 2.0 (1.0; 2.0) | 2.0 (1.0; 2.0) | 0.19 |
| Anti-parotitis IgG, Me/ml | 2.0 (1.2; 4.3) | 2.8 (1.3; 5.6) | 2.5 (1.0; 5.1) | 0.47 |
| Protective anti-parotitis IgG level, n (%) | 12 (86) | 62 (84) | 62 (76) | 0.38 |
| # anti-diphtheria vaccine doses | 5.0 (4.0; 5.0) | 4.0 (4.0; 5.0) | 5.0 (4.0; 5.0) | 0.39 |
| Anti-diphtheria IgG, Me/ml | 0.17 (0.0; 1.2) | 0.18 (0.0; 0.4) | 0.1 (0.0; 0.2) | 0.18 |
| Protective anti-diphtheria IgG level, n (%) | 9 (64) | 42 (57) | 37 (45) | 0.22 |
| # anti-hepatitis B vaccine doses | 3.0 (3.0; 3.0) | 3.0 (3.0; 3.0) | 3.0 (3.0; 3.0) | 0.91 |
| Anti-hepatitis B IgG, Me/ml | 0.56 (0.0; 7.5) | 11.4 (0.3; 44.8) | 10.0 (0.0; 44.1) | 0.08 |
| Protective anti-hepatitis B IgG level, n (%) | 3 (21) | 40 (54) | 42 (51) | 0.08 |
| # anti-rubella vaccine doses | 2.0 (2.0; 2.0) | 2.0 (1.0; 2.0) | 2.0 (1.0; 2.0) | 0.19 |
| Anti-rubella IgG, Me/ml | 121.8
| 95.6
| 56.4
| 0.008 |
| Protective anti-rubella IgG level, n (%) | 14 (100) | 73 (100) | 80 (98) | 0.34 |
Conclusion: MTX, biologics and JIA durations are factors influenced on anti-vaccine antibody level. It is necessary to regularly check the levels of anti-vaccine antibodies, especially anti-measels and anti-diphtheria for creation of the individual vaccination plan for JIA patients, treated with MTX and biologics.
Disclosure of Interests: None declared