Current treatments for juvenile idiopathic arthritis

Abstract

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases, most of which differ from the main adult-onset inflammatory joint diseases. Nonsystemic forms of JIA (oligoarthritis, polyarthritis with or without rheumatoid factors, and spondyloarthropathies) are managed similarly to adult-onset rheumatoid arthritis or spondylarthritis, with a few differences. More specifically, JIA-associated chronic uveitis may require the use of biotherapies that remain experimental in JIA, such as monoclonal antibodies to TNFα or abatacept. International networks have enabled therapeutic trials of medications targeting TNFα alpha, interleukin (IL)-1, IL-6, or T-cell co-stimulation (abatacept). Systemic-onset JIA (also called childhood-onset Still's disease) raises specific treatment challenges and may require treatment with IL-1 antagonists, tocilizumab, or even thalidomide; as a very last resort, intensive immunosuppressant therapy with autologous hematopoietic stem-cell transplantation may be considered. Close monitoring of growth velocity and bone mass accrual is in order, and some patients require additional medications such as growth hormone. Patients with JIA should be managed in specialized centers that have coordinated chains of care for the entire pediatric period and into adulthood. In addition, the use in pediatric patients of recently introduced treatments requires close monitoring for long-term side effects.