title: Management of Juvenile Idiopathic Arthritis: A Clinical Guide.
abstract: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of childhood. The outcome in patients with JIA has markedly improved with the advent of biologic drugs. Although early aggressive therapy with biologics seems to be very effective, this approach leads to overtreatment in patients who would respond to classic disease-modifying anti-rheumatic drugs. Therefore, methotrexate remains first-line long-term therapy for most children with polyarticular JIA. Tumor necrosis factor-α inhibitors have shown tremendous benefit in children with refractory non-systemic JIA. Similar effects have been observed with interleukin-1 and interleukin-6 blockade in patients with systemic JIA. Correct choice and timely use of available medications to achieve early and sustained remission with as few side effects as possible remain challenges for the treating physician. In this review, a practical, clinically oriented guide to the management of JIA is provided, focusing on pharmacological treatment with non-steroidal anti-inflammatory drugs, intra-articular and systemic corticosteroids, disease-modifying anti-rheumatic drugs, and biologic agents. In addition, issues regarding treatment failure, early aggressive treatment, and drug tapering are discussed, with alternative treatment options being suggested.
authors.affiliation: Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1525, Ljubljana, Slovenia.
authors.forename: Štefan
authors.initials: Š
authors.lastname: Blazina
authors.affiliation: Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1525, Ljubljana, Slovenia.
authors.forename: Gašper
authors.initials: G
authors.lastname: Markelj
authors.affiliation: Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1525, Ljubljana, Slovenia.
authors.forename: Mojca Zajc
authors.initials: MZ
authors.lastname: Avramovič
authors.affiliation: Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1525, Ljubljana, Slovenia.|Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Nataša
authors.initials: N
authors.lastname: Toplak
authors.affiliation: Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1525, Ljubljana, Slovenia. tadej.avcin@kclj.si.|Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. tadej.avcin@kclj.si.
authors.forename: Tadej
authors.identifier: http://orcid.org/0000-0001-8409-9092
authors.initials: T
authors.lastname: Avčin
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D001685:Biological Factors / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use; D002648:Child; D006801:Humans; D007375:Interleukin-1 / Q000037:antagonists & inhibitors; D008727:Methotrexate / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha; D000093242:Interleukin-6 Inhibitors; D015850:Interleukin-6
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D001685:Biological Factors; D001688:Biological Products; D007375:Interleukin-1; D008727:Methotrexate; D014409:Tumor Necrosis Factor-alpha; D000093242:Interleukin-6 Inhibitors; C508600:IL6 protein, human; D015850:Interleukin-6