Drug treatment of juvenile arthritis: accepted therapeutic options.

Juvenile arthritis (JA) is classified into 3 subtypes based primarily on clinical characteristics (sign and symptoms) at onset. For all patients with JA, drug therapy begins with nonsteroidal antiinflammatory drugs (NSAIDs) from which there are a number of pediatric approved compounds to choose. If disease activity persists after an adequate NSAID trial, a second-line agent, typically methotrexate, is added. In patients with a small number of resistant joints, in the absence of other illness manifestations, intraarticular corticosteroids (triamcinolone hexacetonide) can be used to induce remission. Some children with severe JA, particularly systemic onset disease, will require the addition of systemic corticosteroids for symptom control. Further treatment has been less well evaluated but includes intravenous immunoglobulin, drug combination cytotoxic therapy and biologic agents. The latter will be increasingly studied in the pediatric population in the future, but are currently reserved for severely unresponsive disease. Management of JA extends beyond drugs, to incorporate occupational and physical therapy, appropriate mental health care and a family centered strategy that seeks to achieve the highest attainment and quality of life for these patients and their families.