Update on the medical treatment of juvenile idiopathic arthritis.
Many exciting developments in the treatment of juvenile idiopathic arthritis (JIA) have emerged recently, including new tools to assess the results of clinical trials (eg, the definition of remission and a radiologic scoring tool). New controlled studies examined the equivalence of meloxicam to naproxen, the efficacy of leflunomide but the superiority of methotrexate, and the use of infliximab in polyarthritis JIA. Initial studies have shown the potential of anti-interleukin (IL)-1 and anti-IL-6 receptor antibody therapy for systemic JIA. Corticosteroid-sparing medications including the use of "biologic modifiers" for JIA-associated uveitis have been described. Evidence-based guidelines for the main subtypes of JIA have been published. However, good evidence on the treatment of several disease subtypes is still lacking. Studies of new medications and the use of combination therapy, including aggressive induction therapy early in the disease course, are necessary to continue improving the outcome of JIA patients.
Hashkes
Philip J
PJ
Department of Rheumatic Diseases A50, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. hashkep@ccf.org
Laxer
Ronald M
RM
D019138:Antibodies, Blocking / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D000069285:Infliximab; D007555:Isoxazoles / Q000627:therapeutic use; D000077339:Leflunomide; D000077239:Meloxicam; D008727:Methotrexate / Q000627:therapeutic use; D009288:Naproxen / Q000627:therapeutic use; D012219:Rheumatology / Q000379:methods* / Q000639:trends; D013843:Thiazines / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use
D019138:Antibodies, Blocking; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D007155:Immunologic Factors; D007555:Isoxazoles; D013843:Thiazines; D013844:Thiazoles; D009288:Naproxen; D000069285:Infliximab; D000077339:Leflunomide; D000077239:Meloxicam; D008727:Methotrexate