[Drug treatment in juvenile chronic arthritis]

NSAIDs are first line drug in the treatment of juvenile chronic arthritis (JCA), mainly in pauciarticular onset. New agents such as naproxen and ibuprofen are frequently preferred because of equivalent efficacy, lower toxicity and longer half-life than salicilates. Antimalarics, sulphasalazine and penicilamine are good options in seronegative JCA, specially with limited articular involvement and in pauciarticular JCA that become polyarticular. However, in the absence of a response with these drugs and insevere polyarticular disease, seropositive JCA and in polyarticular involvement associated to systemic manifestations, low-dose methotrexate is our first choice. Steroids are important in specific life-threatening disease, severe fever and iritis, and should be discontinued as soon as possible. Cytotoxics and immunomodulators should be reserved for active disease unresponsive to conventional therapy.