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PEDIATRICS Vol. 109 No. 1 January 2002, pp. 109-115

SPECIAL ARTICLE

Current Treatment of Juvenile Rheumatoid Arthritis

Norman T. Ilowite, MD

From the Division of Rheumatology, Schneider Children’s Hospital, New Hyde Park, New York, and Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.

--> Prognostic factors in juvenile rheumatoid arthritis (JRA) include polyarticular onset, polyarticular disease course, and rheumatoid factor positivity; in the systemic onset subtype, persistence of systemic features at 6 months after onset confers a worse prognosis. Timely diagnosis and appropriate aggressive treatment of patients with poor prognostic features improve quality of life and outcome. After nonsteroidal anti-inflammatory drugs, methotrexate is the most commonly used second-line agent. However, approximately one third of patients do not respond to methotrexate adequately. Randomized, placebo-controlled, clinical trials in patients with JRA are few, but one such trial with the tumor necrosis factor inhibitor etanercept shows that this drug is effective and well-tolerated. Other recently approved agents for rheumatoid arthritis, including infliximab, leflunomide, celecoxib, and rofecoxib, have not been adequately studied in pediatric patients, and the role of these agents in children with JRA remains to be determined.

Key Words: antirheumatic agents • disease-modifying antirheumatic drugs • tumor necrosis factor

Abbreviations: JRA, juvenile rheumatoid arthritis • RA, rheumatoid arthritis • NSAID, nonsteroidal antiinflammatory drug • FDA, Food and Drug Administration • COX, cyclooxygenase • DMARD, disease-modifying antirheumatic drug • JCA, juvenile chronic arthritis • TNF, tumor necrosis factor; LT-{alpha}, lymphotoxin-{alpha}

Received for publication Apr 20, 2001; Accepted Jun 26, 2001.


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