Recent advances in the management of juvenile idiopathic arthritis

The medical management of polyarthritis in the different subtypes of juvenile idiopathic arthritis has been revolutionized over the past decade. The use of methotrexate has undergone extensive clinical trials and post-marketing monitoring. The safe and effective range of dosages has been defined. Other conventional disease-modifying drugs may also improve those with methotrexate-resistant arthritis. The outcome and quality of life in approximately 60% of children with arthritis has been substantially improved as a result. The advent of biologics has been a further advance towards a new generation of novel therapies aimed at specific inflammatory molecules found to be relevant in different diseases. The use of anti-tumour necrosis factor therapy in those who fail on methotrexate further decreases the number of children with chronic inflammation and undesirable secondary effects such as growth failure, osteoporosis and deformities.