Treatment strategies for juvenile idiopathic arthritis.

IMPORTANCE OF THE FIELD: Treatment of juvenile idiopathic arthritis has markedly improved in the last decade and induction of remission became a reachable goal. AREAS COVERED IN THIS REVIEW: For this review the current literature about clinical trials in JIA is summarized including those substances and strategies currently not approved for treatment. WHAT THE READER WILL GAIN: With this information, the reader receives an overview on the current available treatment options and will be enabled to guide modern treatment of the several JIA subgroups. Take home messages: Current treatment strategies in juvenile idiopathic arthritis (JIA) - including conventional and new therapeutics, biologics - have changed the outcome of JIA. Treatment with TNF inhibitors lead to a rapid and sustained suppression of inflammation and can effectively be used for treatment of polyarticular JIA. Blockers to further pro-inflammatory cytokines, IL-1 and IL-6 are most valuable for treatment of systemic-onset JIA. Blockers of T-cell activation are an alternative approach, slowly acting but targeting to complete inactivation of the disease. Future concepts for the post-biologics era of treatment of rheumatic diseases use antigen-specific tolerance induction and modulation of the immune response. Clinical remission has now become a reachable target in the treatment of JIA.