Etanercept in juvenile rheumatoid arthritis

OBJECTIVE: TO review the classification, pathophysiology, safety, and effic acy of treatment options for juvenile rheumatoid arthritis (JRA). Etanercep t, the agent most recently approved by the Food and Drug Administration for use in JRA, is featured. DATA SOURCES: Articles were identified from a search of the MEDLINE databas e (1966 to January 2000) and through secondary sources. Meeting abstracts a nd posters were also evaluated. STUDY SELECTION AND DATA EXTRACTION: Articles identified and retrieved from data sources were evaluated and, ii determined to be relevant, were includ ed in this review. DATA SYNTHESIS: JRA represents a major cause of functional disability in ch ildren. In contrast to traditional therapeutic agents for JRA, which act th rough generalized antiinflammatory activity or generalized immunosuppressio n, new therapeutic modalities have been developed that target specific mole cules involved in the pathophysiology of JRA. Etanercept inhibits the activ ity of tumor necrosis factor and lymphotoxin-cx. In a clinical trial of pat ients with polyarticular-course JRA, etanercept-treated patients experience d less pain and swelling in their joints, decreased incidence of disease ac tivity, less frequent flare, and a longer time to flare than patients recei ving placebo. Treatment with etanercept was generally well-tolerated. CONCLUSIONS: Etanercept represents an exciting new therapeutic option for t he treatment of JRA. The positioning of etanercept among other therapeutic options for JRA will be more clearly established as additional safety and e fficacy data are made available.