Current medication choices in juvenile rheumatoid arthritis II - Update ofa survey performed in 1993

The documentation of treatments used for juvenile Rheumatoid Arthritis (JRA ) is important to allow for the evaluation of practice patterns for future outcome studies. A survey of nine pediatric rheumatologists was performed b etween September 1999 and February 2000. Each of the physicians prospective ly recorded demographic and treatment information on consecutively sampled JRA patients (n = 395). Pauciarticular onset JRA was present in 46%, polyar ticular onset JRA in 35%, and systemic onset JRA in 19% of the children. Na proxen was the most frequently prescribed medication (55% of the patients), followed by methotrexate (MTX), which was used in 39% of the patients. Fol ic acid supplementation (1 mg/day) was provided to 69% of the patients trea ted with MTX. Etanercept was used in 11% of the children. Eleven percent of the patients received corticosteroids, and 13% of children on corticostero ids took calcium supplements. Uveitis was present in 8% and had a chronic c ourse in 79% of those cases. Although systemic medications were used in 50% of the children with uveitis to control eve inflammation, severe damage to the eyes developed in 30% of them. Fourteen percent of the patients requir ed gastroprotective medications. Compared with findings of a similar survey performed in 1993, there was no significant change in the frequency of use of naproxen, but nabumetone is now more often prescribed, and COX-2 inhibi tors have been introduced in the therapy of JRA. Changes among second-line agents used for JRA have also occurred, although there was no change in the frequency of use of MTX or corticosteroids. JRA continues to be a treatmen t challenge for the practicing pediatric rheumatologist. Patients often sho w incomplete response to the currently available medications. Therefore, ne w therapeutic agents need to be evaluated for their use in JRA, and the tre atment of JRA associated uveitis especially needs to be improved.