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Management of Children with Juvenile Idiopathic Arthritis

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Abstract

Juvenile idiopathic arthritis (JIA) comprises a group of heterogeneous disorders of chronic arthritis in childhood and remains the commonest pediatric rheumatic disease associated with significant long-term morbidity. Advances in understanding of the pathogenesis, better definition of disease control/remission measures, and the arrival of biological agents have improved the outcomes remarkably. Methotrexate (Mtx) remains the first-line disease modifying (DMARD) therapy for most children with JIA due to its proven efficacy and safety. Sulphosalazine (SSz) (especially for enthesitis) and leflunomide may also have a secondary role. Tumor necrosis factor inhibitors (TNF-I), alone or in combination with Mtx have shown tremendous benefit in children with polyarticular JIA, enthesitis related arthritis (ERA) and psoriatic arthritis. Tocilizumab appears very efficacious in systemic arthritis and abatacept and tocilizumab also appear to benefit polyarticular JIA; the role of rituximab remains unclear, though clearly beneficial in adult RA. TNF-I with Mtx is also effective in uveitis associated with JIA. Biologicals have demonstrated an impressive safety record in children with JIA, although close monitoring for rare but potentially dangerous adverse events, such as tuberculosis and other infections; paradoxical development of additional autoimmune diseases; and possibly an increased risk of cancers is warranted.

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Contributions

VV and KJM: Involved in the review of literature and drafting the manuscript. Both authors read and approved the final manuscript. KJM will act as guarantor for the paper.

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Authors and Affiliations

  1. Department of Pediatrics, Pediatric Rheumatology Clinic, Jupiter Hospital, Thane, Mumbai, India

    Vijay Viswanathan

  2. Department of Pediatrics, Pediatric Rheumatology Clinic, MGM New Bombay Hospital, Vashi, Mumbai, Maharashtra, 400703, India

    Vijay Viswanathan

  3. Department of Pediatrics, Pediatric Rheumatology Clinic, Princess Margaret Hospital for Children, Perth, Western Australia, Australia

    Kevin J. Murray

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  1. Vijay Viswanathan
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Correspondence to Vijay Viswanathan.

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Viswanathan, V., Murray, K.J. Management of Children with Juvenile Idiopathic Arthritis. Indian J Pediatr 83, 63–70 (2016). https://doi.org/10.1007/s12098-015-1966-1

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  • DOI: https://doi.org/10.1007/s12098-015-1966-1

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