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Management of Juvenile Idiopathic Arthritis: A Clinical Guide

  • Therapy in Practice
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Abstract

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of childhood. The outcome in patients with JIA has markedly improved with the advent of biologic drugs. Although early aggressive therapy with biologics seems to be very effective, this approach leads to overtreatment in patients who would respond to classic disease-modifying anti-rheumatic drugs. Therefore, methotrexate remains first-line long-term therapy for most children with polyarticular JIA. Tumor necrosis factor-α inhibitors have shown tremendous benefit in children with refractory non-systemic JIA. Similar effects have been observed with interleukin-1 and interleukin-6 blockade in patients with systemic JIA. Correct choice and timely use of available medications to achieve early and sustained remission with as few side effects as possible remain challenges for the treating physician. In this review, a practical, clinically oriented guide to the management of JIA is provided, focusing on pharmacological treatment with non-steroidal anti-inflammatory drugs, intra-articular and systemic corticosteroids, disease-modifying anti-rheumatic drugs, and biologic agents. In addition, issues regarding treatment failure, early aggressive treatment, and drug tapering are discussed, with alternative treatment options being suggested.

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Authors and Affiliations

  1. Department of Allergology, Rheumatology and Clinical Immunology, Children’s Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1525, Ljubljana, Slovenia

    Štefan Blazina, Gašper Markelj, Mojca Zajc Avramovič, Nataša Toplak & Tadej Avčin

  2. Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

    Nataša Toplak & Tadej Avčin

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  1. Štefan Blazina
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Correspondence to Tadej Avčin.

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Tadej Avčin declares speakers bureau (AbbVie, Pfizer, Octapharma) and advisory board (Bristol-Myers Squibb, Octapharma). Štefan Blazina, Gašper Markelj, Mojca Zajc Avramovič and Nataša Toplak have no conflicts of interest that are relevant to the content of this review.

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This work was partially supported by the University Medical Center Ljubljana (research Grant Number 20140208).

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Blazina, Š., Markelj, G., Avramovič, M.Z. et al. Management of Juvenile Idiopathic Arthritis: A Clinical Guide. Pediatr Drugs 18, 397–412 (2016). https://doi.org/10.1007/s40272-016-0186-0

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