Update on treatment of arthritis in children: new treatments, new goals.

Although improved in recent years, the outcome for children who have juvenile idiopathic arthritis (JIA) is still less than ideal. Between 25% and 70% of children with JIA will still have active arthritis 10 years after disease onset, and over 40% will enter adulthood with active arthritis. Based on older publications, the fatality rate for JIA is 4- to 14-fold greater than an age- and sex-matched healthy population, and up to 39% of patients are significantly incapacitated, either wheelchair-bound or bedridden (Steinbrocker Classes III or IV). The hope is that recent changes in treatment approaches will result in marked improvement in long-term functional outcomes, although this has yet to be proven. JIA-associated chronic uveitis has a high frequency of serious complications: 20% develop cataracts, 19% glaucoma, and 16% band keratopathy. The anti-TNF biologics have all been tested in children with polyarticular JIA in blinded, placebo-controlled clinical trials, with over 70% in each trial demonstrating response that has been sustained in longer term follow-up studies. In systemic JIA approximately 50% respond to anti-TNF agents, but in many the response is not sustained. Openlabel studies have shown promising results for biologic therapies that block interleukins 1 and 6 in systemic JIA.