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Current treatment of juvenile rheumatoid arthritis
1Division of Rheumatology, Schneider Children's Hospital, New Hyde Park, New York, USA. ilowite@lij.edu
Insights
Identifying poor prognostic factors in juvenile rheumatoid arthritis (JRA) is key for timely treatment. While methotrexate is a common second-line therapy, etanercept shows promise for non-responders in JRA patients.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Clinical Trials
Background:
- Juvenile rheumatoid arthritis (JRA) prognosis is influenced by factors like polyarticular onset, disease course, and rheumatoid factor status.
- For systemic onset JRA, persistent systemic features at six months indicate a poorer outcome.
- Early diagnosis and aggressive treatment are crucial for improving quality of life and outcomes in JRA.
Purpose of the Study:
- To review prognostic factors in juvenile rheumatoid arthritis (JRA).
- To discuss current treatment strategies and limitations, including methotrexate's efficacy.
- To evaluate the role of newer biologic agents, such as etanercept, in pediatric JRA management.
Main Methods:
- Review of existing literature on JRA prognostic factors.
- Analysis of treatment guidelines and clinical trial data for JRA.
- Examination of the efficacy and safety of methotrexate and biologic agents in JRA.
Main Results:
- Polyarticular onset/course and rheumatoid factor positivity are negative prognostic indicators in JRA.
- Methotrexate is a standard second-line treatment, but approximately one-third of JRA patients show inadequate response.
- A randomized trial demonstrated etanercept's effectiveness and good tolerability in JRA patients.
Conclusions:
- Identifying and managing JRA patients with poor prognostic factors is essential.
- Etanercept represents a viable and effective treatment option for JRA patients unresponsive to methotrexate.
- Further research is needed to establish the role of other biologic and targeted therapies in pediatric JRA.
Abstract:
Prognostic factors in juvenile rheumatoid arthritis (JRA) include polyarticular onset, polyarticular disease course, and rheumatoid factor positivity; in the systemic onset subtype, persistence of systemic features at 6 months after onset confers a worse prognosis. Timely diagnosis and appropriate aggressive treatment of patients with poor prognostic features improve quality of life and outcome. After nonsteroidal anti-inflammatory drugs, methotrexate is the most commonly used second-line agent. However, approximately one third of patients do not respond to methotrexate adequately. Randomized, placebo-controlled, clinical trials in patients with JRA are few, but one such trial with the tumor necrosis factor inhibitor etanercept shows that this drug is effective and well-tolerated. Other recently approved agents for rheumatoid arthritis, including infliximab, leflunomide, celecoxib, and rofecoxib, have not been adequately studied in pediatric patients, and the role of these agents in children with JRA remains to be determined.