Treatment of juvenile rheumatoid arthritis.

Advances in pediatric rheumatology have closely paralleled those in adult rheumatology, but several unique features of JRA have led to some prominent differences. Methotrexate has clearly become the gold standard for use in moderate to severe disease. A variety of the second-line agents and newer methods of corticosteroid dosing can be used in milder disease or in patients who fail or refuse methotrexate. Biologic agents and newer immunosuppressive agents hold out significant promise for those with the most severe disease. As for adult disease, a cure for arthritis is far away, but the lives of these patients have truly been revolutionized by the wide array of newer therapies.