Aggressive treatment in childhood rheumatic diseases.

Much remains to be learned about the optimal therapy for children with rheumatic diseases. Current therapies remain inexact and are aimed at either the inflammatory or the immune responses of patients. There have been a few advances, for example in the treatment of children with dermatomyositis, lupus and, in particular, Kawasaki disease. Progress in the treatment of juvenile rheumatoid arthritis (JRA) and the spondylarthropathies has lagged behind, however, although methotrexate does appear to be promising in the short-term treatment of JRA. Another urgent problem which remains to be resolved is the identification of those children who will have poor outcomes and who warrant early, aggressive treatment. A number of interesting alternative therapies for adults have been proposed, but their applicability to children remains an open question. Further investigation of combined therapies with various drugs also warrants exploration.