Chronic salicylate administration in juvenile rheumatoid arthritis: aspirin "hepatitis" and its clinical significance.

Salicylates provide the backbone of therapy in juvenile rheumatoid arthritis. They are effective in controlling the disease approximately 75% of the time if they are properly used. Salicylate administration is relatively safe if carefully done. Serum salicylate levels should not exceed 30 mg/dl routinely. Patients, physicians, and parents should be alert to early clinical signs of toxicity. Chief hazards of chronic salicylate administration other than salicylism (which should be uniformly preventable) include gastric irritation with questionable relationship to peptic ulcer disease, and rare serious hepatotoxicity, bleeding diatheses, or hypersensitivity reactions.