Medical treatment of juvenile arthritis.

The range of medications available to treat juvenile arthritis has markedly expanded over the past 15 years. Multiple new nonsteroidal antiinflammatory drugs (NSAIDs) are available in the United States, although only a few are approved for use in children, and none have been proven to be significantly better than aspirin in suppressing inflammation. The average time before significant improvement is noticed is over 30 days in the 50% of the children who respond to any NSAID within three months. The percentage of responders progressively increases with the length of therapy, so treatment should be continued until one is reasonably certain that improvement will not occur before changing medication. In the more severely involved child, gold and other disease-modifying medications are used. However, it has been difficult to prove the value of these medications in controlled studies because of the high rate of significant improvement in the control group treated with NSAIDs. In preliminary studies, methotrexate appears to have significant benefit in children who have failed other treatments. Other newer therapies, such as intravenous gammaglobulin, have only been used in a small number of patients and have not as yet been proven beneficial.