The treatment of juvenile arthritis.
Until recently, two different classification systems for juvenile arthritis (JA) were utilised, each with its own terminology and subclassification. It has been recognised that particularly within the polyarticular and pauciarticular groups, many distinct subsets exist each with a different prognosis. As a result, a new classification system for JA has been developed. It is hoped that this will allow more accurate assessment of incidence and aetiology of the various subtypes in future generations and in time will allow therapy to be targeted at those most likely to achieve benefit. Since there is a new classification system for JA, the vast majority of published clinical studies were performed using the old classification system. For the purposes of this review, unless otherwise stated, the American College of Rheumatology classification will be used. This is outlined in Table 1 with clinical features of the major subtypes described in Table 3. This review will cover current best practice and discuss future directions for research using the recent advances in the treatment of rheumatoid arthritis (RA) as a model.
Hamilton
J
J
Centre for Rheumatic Diseases, Royal Infirmary, Glasgow, UK.
Capell
H
H
D000686:Amyloidosis / Q000517:prevention & control; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D000068800:Etanercept; D005493:Folic Acid Antagonists / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D000069285:Infliximab; D008727:Methotrexate / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D010024:Osteoporosis / Q000517:prevention & control; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D014605:Uveitis / Q000517:prevention & control
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D016861:Cyclooxygenase Inhibitors; D005493:Folic Acid Antagonists; D005938:Glucocorticoids; D007074:Immunoglobulin G; D007155:Immunologic Factors; D018124:Receptors, Tumor Necrosis Factor; D000069285:Infliximab; D000068800:Etanercept; D008727:Methotrexate