Advances in the medical treatment of juvenile rheumatoid arthritis.
Juvenile rheumatoid arthritis (JRA) remains a challenge for clinicians. Nonsteroidal anti-inflammatory drugs and corticosteroids remain the mainstays of therapy, but concerns persist about side effects and the ability of these agents to prevent progression of bony disease. In recent years, novel treatments have been developed and quickly discarded because of unexpected toxicities or lack of efficacy. However, recent studies have shown that methotrexate and sulfasalazine are relatively safe and effective for JRA. Newly developed drugs, such as selective cyclooxygenase-2 inhibitors and soluble tumor necrosis factor receptor, whose development has stemmed from a more basic understanding of pathophysiology, may provide better disease control with fewer side effects. Finally, novel therapies, such as stem cell transplantation, may offer hope for children with JRA, especially systemic-onset JRA, whose disease has been refractory to conventional therapy.
Onel
K B
KB
Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA. onelk@has.edu
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy* / Q000628:therapy; D002648:Child; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007270:Injections, Intra-Articular; D008727:Methotrexate / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents; D016861:Cyclooxygenase Inhibitors; D008727:Methotrexate