Treatment options with biologics for juvenile idiopathic arthritis. (June 2011)

• Record Type: Journal Article
• Authors: Horneff, Gerd
• Is Part Of: International journal of clinical rheumatology. Volume 6:Number 3(2011)
• Page Start: 305
• Page End: 323
• Publication Date: 2011-06
• Subjects: abatacept -- adalimumab -- anakinra -- canakinumab -- etanercept -- infliximab -- juvenile arthritis -- rituximab -- tocilizumab; Rheumatology -- Periodicals; 616.723005
• DOI: 10.2217/ijr.11.26
• Languages: English
• ISSNs: 1758-4272

Abstract

Due to recent years'' innovative developments in the pharmacotherapy of juvenile idiopathic arthritis (JIA) the induction of remission has become a reachable goal. Remission will lead to less structural damage and fewer disabilities. In this review, treatment options will be discussed on the basis of clinical trials and long-term documentation of treatment experience for the different drugs. In persistent oligoarticular JIA intra-articular corticosteroids and NSAIDs are both used as a first-line treatment. Despite this, for polyarticular JIA including seropositive and seronegative polyarthritis, extended oligoarthritis and polyarticular course of psoriasis arthritis early treatment with disease-modifying drugs is indicated. Methotrexate is currently the most commonly used ''first-line'' disease-modifying drug in these JIA categories, while sulfasalazine has been proven effective in HLA-B27-associated enthesitis-related arthritis patients. After failure of these first-line treatment options, step up strategies introducing treatment with either of the TNF inhibitors etanercept and adalimumab is indicated. Leflunomide, infliximab or abatacept are alternatives for treatment of polyarticular JIA, while biological agents targeting IL-1 (anakinra, rilonacept and canakinumab) and IL-6 activity (tocilizumab) are successful in treating patients with systemic-onset JIA. While these strategies have already entered national and international treatment guidelines, the superiority of combination regimens of disease-modifying drugs and biologics remains to be established and switching strategies for patients with resistant or residual disease have to be developed.