New drug therapies for the pediatric rheumatic diseases

Such developments as the introduction of whole new drug classes, as well as the general increase in pediatric drug trials, have led to a revolution in pediatric rheumatology care. For example, selective cyclooxygenase-2 inhib itors can provide the same symptomatic relief as nonselective nonsteroidal anti-inflammatory agents without the same concerns over significant gastroi ntestinal toxicity. Biologic agents, notably the tumor necrosis factor inhi bitors, have effected dramatic improvements in many patients with severe di sease who previously were often significantly disabled. New immunosuppressi ves, such as mycophenolate mofetil, also have promise for ameliorating syst emic lupus and vasculitic conditions, perhaps with reduced toxicity compare d with other agents. New strategies for the use of older agents have also b een further substantiated, such as intra-articular steroid and alternate-da y high-dose steroid in chronic arthritis, and broader use of sulfasalazine. Evidence for the use of these therapies is discussed, as are potential tox icities. (C) 2001 Lippincott Williams & Wilkins, Inc.