Treatment strategies for juvenile idiopathic arthritis

Abstract

Importance of the field: Treatment of juvenile idiopathic arthritis has markedly improved in the last decade and induction of remission became a reachable goal.

Areas covered in this review: For this review the current literature about clinical trials in JIA is summarized including those substances and strategies currently not approved for treatment.

What the reader will gain: With this information, the reader receives an overview on the current available treatment options and will be enabled to guide modern treatment of the several JIA subgroups.

Take home messages: Current treatment strategies in juvenile idiopathic arthritis (JIA) – including conventional and new therapeutics, biologics – have changed the outcome of JIA. Treatment with TNF inhibitors lead to a rapid and sustained suppression of inflammation and can effectively be used for treatment of polyarticular JIA. Blockers to further pro-inflammatory cytokines, IL-1 and IL-6 are most valuable for treatment of systemic-onset JIA. Blockers of T-cell activation are an alternative approach, slowly acting but targeting to complete inactivation of the disease. Future concepts for the post-biologics era of treatment of rheumatic diseases use antigen-specific tolerance induction and modulation of the immune response. Clinical remission has now become a reachable target in the treatment of JIA.

Keywords::

• abatacept
• adalimumab
• anakinra
• canakinumab
• etanercept
• infliximab
• juvenile idiopathic arthritis
• leflunomide
• methotrexate
• tocilizumab