Emerging Therapies in Juvenile Rheumatoid/Idiopathic Arthritis

Abstract

4 J uvenile rheumatoid arthritis (JRA) is a heterogeneous group of diseases in children, which are all characterized by arthritis in at least one oint for a minimum of 6-weeks duration. There has een an international transition in the nomenclature to ename this group of diseases juvenile idiopathic rthritis (JIA). JIA also includes psoriatic arthritis and he spondyloarthropathies, which are not included in he spectrum of JRA. Nonetheless, we have learned hat the therapies for these diseases overlap considerbly and are not necessarily distinctive in one group ersus another. Treatments for these chronic arthritic conditions in hildren have evolved over the last three decades. The apid progressive addition of antiinflammatory agents as evolved in parallel with the treatment recommenations for adult patients with rheumatoid arthritis. his “dismantling of the pyramid” was expedited by he report of Levinson and Wallace in 1992. Their eport demonstrated that, based on plain film joint adiographs, there is a relatively narrow window of pportunity to treat these diseases before cartilage arrowing or bone erosion occurs. The patients with olyarticular and systemic JRA had a mean onset of bnormal radiographs in approximately 2.5 years and atients with pauciarticular JRA (oligoarticular JIA) verage approximately 5 years until they exhibit abormal radiographs. Thus, antiinflammatory treatment s implemented faster to protect the cartilage and reserve the intraarticular anatomy.