Juvenile idiopathic arthritis in the new world of biologics

Abstract

Juvenile idiopathic arthritis results in significant pain and disability in both children and adults. Advances in treatment resulting in improved long-term outcomes have occurred; however, an emphasis on early and aggressive diagnosis and management hopes to improve outcomes further. Juvenile idiopathic arthritis remains a clinical diagnosis of exclusion, but further research may delineate biological markers associated with the disease and its subtypes. Therapy for patients includes intra-articular steroid injections, disease modifying agents such as methotrexate and biological agents. Biological agents have provided exciting new therapeutic options in the last decade; however, long-term side effects of modulating the immune system are not yet fully understood. Systemic steroids may also be required but their long-term use is avoided. Uveitis needs to be screened for in all of those with the diagnosis. Multidisciplinary team care is required in managing these young people.

Being as Normal as Possible: How Young People Ages 16–25 Years Evaluate the Risks and Benefits of Treatment for Inflammatory Arthritis

“…Like older adults, young people with inflammatory arthritis (IA) can have severe disease warranting aggressive treatment, including biologic agents . In other respects, however, they are different.…”

Juvenile Idiopathic Arthritis: A Focus on Pharmacologic Management

“…The management of JIA involves a multidisciplinary approach. Nonpharmacologic therapy such as physical, occupational, and psychosocial (e.g., mental health, psychiatric) therapies have all been used to help manage the disease process in conjunction with pharmacologic agents (Giancane et al, 2016;Ostring & Singh-Grewal, 2013). Assistive device (wheelchairs, walkers), aerobic conditioning, and splinting are all techniques used to help maintain physical functioning and prevent development of disability.…”

Efficacy and safety of intravitreal anti‐tumour necrosis factor drugs in adults with non‐infectious uveitis – a systematic review

“…), sarcoidosis (Maneiro et al. ) or juvenile idiopathic arthritis (Ostring & Singh‐Grewal ; Kalinina Ayuso et al. ).…”

“…As a pleiotropic and multifunctional cytokine, TNF plays a pivotal role in ocular inflammation, via reactive oxygen species, promotion of angiogenesis and breakdown of the blood-retinal barrier (BRB), being associated with the development of sightthreatening NIU-associated complications (Caspi 2006(Caspi , 2010Pulido et al 2010;Shim 2011;Markomichelakis et al 2012;Levy-Clarke et al 2014;Cordero-Coma & Sobrin 2015). Anti-TNF drugs have established efficacy in several systemic inflammatory conditions related to NIU such as Behc ßet disease (Hatemi et al 2008), spondyloarthritis (Zochling et al 2006), sarcoidosis (Maneiro et al 2012) or juvenile idiopathic arthritis (Ostring & Singh-Grewal 2013;Kalinina Ayuso et al 2014). The inactivation of TNF can been achieved with mAb, such as infliximab, adalimumab, golimumab and certolizumab pegol, or with receptor fusion proteins, as etanercept (Pulido et al 2010;Levy-Clarke et al 2014;Cordero-Coma & Sobrin 2015).…”