The place of corticosteroid therapy in juvenile chronic arthritis in 1992

Juvenile chronic arthritis (JCA) is a heterogeneous disease, treated with systemic or local corticosteroid therapy. Systemic corticosteroids are indicated in systemic JCA only when nonsteroidal antiinflammatory drugs have failed or cause side effects or if there is evidence of severe pericarditis. Intravenous pulses of methylprednisolone produce little benefit. Corticosteroid therapy must be tapered slowly, and it may take a long time to reach an alternate day regimen. Side effects are the most worrying problem with daily therapy, particularly growth arrest. Some cases of polyarticular JCA with severe functional impairment and unresponsive to other therapies may benefit from systemic corticosteroids. The most powerful drug for the treatment of joints is triamcinolone hexacetonide, which produces excellent responses in two-thirds of knee joint cases treated. Local corticosteroid therapy is also indicated for chronic iridocyclitis.