Comparative tolerability of treatments for juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) includes several forms of chronic arthr itis in children. Treatments are chosen according to the type and severity of the disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticost eroids remain the mainstays of therapy. Traditional slower acting anti-rheu matic drugs, such as gold therapy, penicillamine, sulfasalazine, tiopronin and hydroxychloroquine, are usually poorly active in children. In addition, adverse effects are common, including severe macrophage activation syndrom e with gold therapy or sulfasalazine. Low dose, once weekly methotrexate ha s emerged as the therapeutic agent of choice for children who fail to respo nd adequately to the administration of an NSAID, especially in those with t he extended oligoarticular subtype of the disease. Other immunosuppressive agents, such as cyclosporin, an sometimes combined with methotrexate. In re cent years, novel treatments have been developed. Autologous hematopoietic stem cell transplantation is effective in a number of children with severe JIA, whose disease has been refractory to conventional therapy. However, on ly short term follow-up data are currently available for this novel therapy . In addition, severe infections complicated by macrophage activation syndr ome and death have been reported. Finally, anti-tumour necrosis factor-alph a: therapy has shown efficacy in more than two-thirds of children with JIA and polyarthritis, and other cytokine inhibitors may he soon available.