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.

Lung function in children with juvenile idiopathic arthritis: A cross‐sectional analysis

“…MTX is an immunosuppressive drug widely used in JIA. 31 The main mechanism of anti-inflammatory action is the modulation of the adenosine pathway resulting in inhibition of phagocytosis and secretion of interferon, interleukin-6 (IL-6), IL-12, and tumor necrosis factor (TNF). 32 MTX-induced pulmonary disease has been studied and well described in adults with RA.…”

Clinical and MRI outcome of cervical spine lesions in children with juvenile idiopathic arthritis treated with anti-TNFα drugs early in disease course

“…2). The early introduction of anti-TNFα in treatment of JIA patients with severe form of the disease provides an opportunity to delay or even prevent severe joint inflammation and subsequent destruction [20, 29]. MRI as objective imaging method has important role in evaluation of treatment response.…”

“…In spite of the limited number of patients, our results demonstrated that early and aggressive treatment of cervical spine arthritis with anti-TNFα could provide good results with elimination of inflammation (early response) and has a potential to reduce/deminish the chronic changes. According to our experience, in all children with persistent LROM MRI should be performed and if inflammation is confirmed, anti-TNFα treatment should be considered [20]. The follow-up MRI examinations are individually addressed.…”

“…We decided to introduce anti-TNFα treatment in all children with proven cervical spine arthritis on MRI [20]. Therefore, the objective of our study was to evaluate the clinical and MRI outcome of cervical spine arthritis in a group of consecutive patients with JIA who received anti-TNFα treatment early in disease course.…”

Prefilled pen versus prefilled syringe: evaluation of methotrexate subcutaneous intake method in patients with juvenile idiopathic arthritis – results of the pilot study

“…Although biologic agents are increasingly used in the management of this condition, methotrexate (MTX) remains the mainstay of JIA treatment [ 3,4 ]. MTX is administered weekly at a dose of 10-15 mg/m 2 either via oral or parenteral route [ 5 ].The bioavailability of MTX is about 15 % higher after subcutaneous administration than after oral intake, leading to the improvement of treatment efficacy [ 6 , 7 ]. Moreover, the most common side effect of MTX therapy: gastrointestinal toxicity, is less pronounced after the MTX injection [ 8 ].…”