New drug therapies for the pediatric rheumatic diseases.
Such developments as the introduction of whole new drug classes, as well as the general increase in pediatric drug trials, have led to a revolution in pediatric rheumatology care. For example, selective cyclooxygenase-2 inhibitors can provide the same symptomatic relief as nonselective nonsteroidal anti-inflammatory agents without the same concerns over significant gastrointestinal toxicity. Biologic agents, notably the tumor necrosis factor inhibitors, have effected dramatic improvements in many patients with severe disease who previously were often significantly disabled. New immunosuppressives, such as mycophenolate mofetil, also have promise for ameliorating systemic lupus and vasculitic conditions, perhaps with reduced toxicity compared with other agents. New strategies for the use of older agents have also been further substantiated, such as intra-articular steroid and alternate-day high-dose steroid in chronic arthritis, and broader use of sulfasalazine. Evidence for the use of these therapies is discussed, as are potential toxicities.
Bloom
B J
BJ
Pediatric Rheumatology Program, Hasbro Children's Hospital, Providence, Rhode Island 02903, USA. bbloom@lifespan.org
D000293:Adolescent; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D000068800:Etanercept; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D008565:Membrane Proteins; D011451:Prostaglandin-Endoperoxide Synthases; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use
D018501:Antirheumatic Agents; D001688:Biological Products; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007074:Immunoglobulin G; D007527:Isoenzymes; D008565:Membrane Proteins; D018124:Receptors, Tumor Necrosis Factor; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases; D000068800:Etanercept