Juvenile idiopathic arthritis--current and future therapies

Juvenile idiopathic arthritis (JIA) consists of a group of heterogeneous disorders of chronic arthritis in childhoodwith no apparent cause. JIA is the most common rheumatic disease in children and may still result in signifcant morbidity, with joint deformity, growth impairment, and persistence of active arthritis into adulthood. In addition to arthritis, the extra-articular features that may be present in JIA, such as anterior uveitis or the fever of systemic-onset JIA, are often the greater focus of therapy. Prior to the mid 1990s, the therapeutic armamentarium for JIA was more limited, utilizing nonspecifc agents, many with signifcant adverse effects. In the new era of target-specifc biologic therapy, the clinician is now able to better tailor therapy for patients with JIA. Still, despite the bells and whistles of biologics, the consistent performance of methotrexate as the gold standard disease-modifying anti-rheumatic drug (DMARD), against which all other agents are compared, cannot be overemphasized. Through continued translational research, rheumatologists better understand the biology behind the clinical symptoms. This review will discuss the clinical features of JIA, as well as past, present, and future therapeutic approaches in the care of children with arthritis.