Abstract
One of the most important and changing areas of research in paediatric rheumatology is the optimum approach to the treatment of children with chronic arthritis. Until recently all medications for children with arthritis were nonspecific in terms of our understanding, albeit poor, of the pathogenesis of these diseases. Of current therapies, low dose, once-a-week methotrexate has emerged as the therapeutic agent of choice for children who fail to respond adequately to administration of a nonsteroidal anti-inflammatory drug. Thereby, it has displaced the more traditional slower acting anti-rheumatic drugs, although one or more of them are often combined with methotrexate in the polypharmaceutical approach to childhood arthritis.
Better and more specific agents are needed, especially for systemic onset disease, unremitting polyarticular involvement, and certain complications such as resistant chronic uveitis. At this time the introduction of the cyclo-oxygenase 2 inhibitors and etanercept (soluble tumour necrosis factorα.p75 fusion protein) may herald an era of more specific and effective therapy.
Similar content being viewed by others
References
Cassidy JT, Petty RE. Textbook of pediatric rheumatology. 3rd ed. Philadelphia: WB Saunders, 1995
Cron RQ, Sharma S, Sherry DD. Current treatment by United States and Canadian pediatric rheumatologists. J Rheumatol 1999; 26: 2036–8
Lindsley CB. Uses of nonsteroidal anti-inflammatory drugs in pediatrics. Am J Dis Child 1993; 147: 229–36
Keenan GF, Giannini EH, Athreya BH. Clinically significant gastropathy associated with nonsteroidal antiinflammatory drug use in children with juvenile rheumatoid arthritis. J Rheumatol 1995; 22: 1149–51
Cryer B, Feldman M. Cyclooxygenase-1 and cyclooxygenase-2 selectivity of widely used nonsteroidal anti-inflammatory drugs. Am J Med 1998; 104: 413–21
Golden BD, Abramson SB. Selective cyclooxygenase-2 inhibitors. Rheum Dis Clin North Am 1999; 25: 359–78
Rumack, B. Asprin and acetaminophen. Pediatrics 1978; (Suppl.) 62: 86S-94S
Pachman LM, Olufs R, Procknal JA, et al. Pharmacokinetic monitoring of salicylate therapy in children with juvenile rheumatoid arthritis. Arthritis Rheum 1979; 22: 826–31
Poe TE, Mutchie KD, Saunders GH, et al. Total and free salicylate concentrations in juvenile rheumatoid arthritis. J Rheumatol 1980; 7: 717–23
Kvien TK, Olsson B, Hoyeraal HM. Acetylsalicylic acid and juvenile rheumatoid arthritis: effect of dosage interval on the serum salicylic acid level. Acta Paediatr Scand 1985; 74: 755–9
Weaver AL, Sullivan RE, Kramer WS. Iatrogenic tooth erosions in juvenile rheumatoid arthritis patients [abstract]. Clin Res 1982; 30: 810A
Tanchyk AR Prevention of tooth erosion from salicylate therapy in juvenile rheumatoid arthritis. Gen Dent 1986; 34: 479–80
Hurwitz ES, Barrett MJ, Bregman D, et al. Public Health Service study of Reye’s syndrome and medications. Report of the main study [published erratum appears in JAMA 1987 Jun 26; 257 (24): 3366]. JAMA 1987; 257: 1905–11
Ulshen MH, Grand RJ, Crain JD, et al. Hepatoxicity with encephalopathy associated with aspirin therapy in rheumatoid arthritis. J Pediatr 1978; 93: 1034–7
Rennebohm RM, Heubi JE, Daugherty CC, et al. Reye syndrome in children receiving salicylate therapy for connective tissue disease. J Pediatr 1985; 107: 877–80
Remington PL, Shabino CL, McGee H, et al. Reye syndrome and juvenile rheumatoid arthritis in Michigan. Am J Dis Child 1985; 139: 870–2
Kauffman RE, Roberts RJ. Aspirin use and Reye syndrome. Pediatrics 1987; 79: 1049–50
Arrowsmith JB, Kennedy DL, Kuritsky JN, et al. National patterns of aspirin use and Reye syndrome reporting, United States, 1980 to 1985. Pediatrics 1987; 79: 858–63
Steans A, Manners PJ, Robinson IG. A multicentre, long-term evaluation of the safety and efficacy of ibuprofen syrup in children with juvenile chronic arthritis. Br J Clin Pract 1990; 44: 172–175
Giannini EH, Brewer EJ, Miller ML, et al. Ibuprofen suspension in the treatment of juvenile rheumatoid arthritis. Pediatric Rheumatology Collaborative Study Group. J Pediatr 1990; 117: 645–52
Makela AL. Naproxen in the treatment of juvenile rheumatoid arthritis: metabolism, safety and efficacy. Scand J Rheumatol 1977; 6: 193–205
Moran H, Hanna DB, Ansell BM, et al. Naproxen in juvenile chronic polyarthritis. Ann Rheum Dis 1979; 38: 152–4
Nicholls A, Hazleman B, Todd RM, et al. Long-term evaluation of naproxen suspension in juvenile chronic arthritis. CurrMed Res Opin 1982; 8: 204–7
Laxer RM, Silverman ED, St-Cyr C, et al. A six-month open safety assessment of a naproxen suspension formulation in the therapy of juvenile rheumatoid arthritis. Clin Ther 1988; 10: 381–7
Leak AM, Richter MR, Clemens LE, et al. A crossover study of naproxen, diclofenac and tolmetin in seronegative juvenile chronic arthritis. Clin Exp Rheumatol 1988; 6: 157–60
Levinson JE, Baum J, Brewer EJ, et al. Comparison of tolmetin sodium and aspirin in the treatment of juvenile rheumatoid arthritis. J Pediatr 1977; 91: 799–804
Gewanter HL, Baum J. The use of tolmetin sodium in systemic onset juvenile rheumatoid arthritis. Arthritis Rheum 1981; 24: 1316–9
Todd PA, Sorkin EM. Diclofenac sodium: a reappraisal of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy [published erratum appears in Drugs 1988 Jul; 36 (1): preceding 1]. Drugs 1988; 35: 244–85
Minisola G, Dardano B, Calderazzo L, et al. Clinical efficacy of sodium diclofenac in chronic juvenile polyarthritis. Pediatr Med Chir 1990; 12: 169–73
Makela AL, Lempiainen M, Ylijoki H. Ibuprofen levels in serum and synovial fluid. Scand J Rheumatol Suppl 1981; 39: 15–7
Brewer EJJ. A comparative evaluation of indomethacin, acetaminophen and placebo as antipyretic agents in children. Arthritis Rheum 1968; 11: 645–51
Sherry DD, Patterson MW, Petty RE. The use of indomethacin in the treatment of pericarditis in childhood. J Pediatr 1982; 100: 995–8
Jacobs JS. Sudden death in arthritic children receiving large doses of indomethacin. JAMA 1967; 199: 932–4
Lovell DJ, Giannini EH, Brewer EJJ. Time course of response to nonsteroidal antiinflammatory drugs in juvenile rheumatoid arthritis. Arthritis Rheum 1984; 27: 1433–7
Athreya BH, Moser G, Cecil HS, et al. Aspirin-induced hepatotoxicity in juvenile rheumatoid arthritis: a prospective study. Arthritis Rheum 1975; 18: 347–52
Wortmann DW, Kelsch RC, Kuhns L, et al. Renal papillary necrosis in juvenile rheumatoid arthritis. J Pediatr 1980; 97: 37–40
Allen RC, Petty RE, Lirenman DS, et al. Renal papillary necrosis in children with chronic arthritis. Am J Dis Child 1986; 140: 20–2
Whelton A, Hamilton CW. Nonsteroidal anti-inflammatory drugs: effects on kidney function. J Clin Pharmacol 1991; 31: 588–98
Allen R, Rogers M, Humphrey I. Naproxen induced pseudoporphyria in juvenile chronic arthritis. J Rheumatol 1991; 18: 893–6
Wallace CA, Farrow D, Sherry DD. Increased risk of facial scars in children taking nonsteroidal antiinflammatory drugs. J Pediatr 1994; 125: 819–22
Levy ML, Barron KS, Eichenfield A, et al. Naproxen-induced pseudoporphyria: a distinctive photodermatitis. J Pediatr 1990; 117: 660–4
Lang BA, Finlayson LA. Naproxen-induced pseudoporphyria in patients with juvenile rheumatoid arthritis. J Pediatr 1994; 124: 639–42
Girschick HJ, Hamm H, Ganser G, et al. Naproxen-induced pseudoporphyria: appearance of new skin lesions after discontinuation of treatment. Scand J Rheumatol 1995; 24: 108–11
Truckenbrodt H, Hafner R. Methotrexate therapy in juvenile rheumatoid arthritis: a retrospective study. Arthritis Rheum 1986; 29: 801–745.
Speckmaier M, Findeisen J, Woo P, et al. Low-dose methotrexate in systemic onset juvenile chronic arthritis. Clin Exp Rheumatol 1989; 7: 647–50
Halle F, Prieur AM. Evaluation of methotrexate in the treatment of juvenile chronic arthritis according to the subtype. Clin Exp Rheumatol 1991; 9: 297–302
Giannini EH, Brewer EJ, Kuzmina N, et al. Methotrexate in resistant juvenile rheumatoid arthritis: results of the USA-USSR double-blind, placebo-controlled trial. The Pediatric Rheumatology Collaborative Study Group and The Cooperative Children’s Study Group. N Engl J Med 1992; 326: 1043–9
Lovell DJ. Ten years of experience with methotrexate: past, present and future. Rev Rhum Engl Ed 1997; 64: 186S–8S
Singsen BH, Goldbach-Mansky R. Methotrexate in the treatment of juvenile rheumatoid arthritis and other pediatric rheumatoid and nonrheumatic disorders. Rheum Dis Clin North Am 1997; 23: 811–40
Wallace CA. The use of methotrexate in childhood rheumatic diseases. Arthritis Rheum 1998; 41: 381–91
Cassidy JT. Outcomes research in the therapeutic use of methotrexate in children with chronic peripheral arthritis [editorial]. J Pediatr 1998; 133: 179–80
Wallace CA, Levinson JE. Juvenile rheumatoid arthritis: outcome and treatment for the 1990s. Rheum Dis Clin North Am 1991; 17: 891–905
Giannini EH, Cassidy JT, Brewer EJ, et al. Comparative efficacy and safety of advanced drug therapy in children with juvenile rheumatoid arthritis. Semin Arthritis Rheum 1993; 23: 34–46
Dupuis LL, Koren G, Silverman ED, et al. Influence of food on the bioavailability of oral methotrexate in children. J Rheumatol 1995; 22: 1570–3
Wallace CA, Sherry DD, Mellins ED, et al. Predicting remission in juvenile rheumatoid arthritis with methotrexate treatment. J Rheumatol 1993; 20: 118–22
Giannini EH, Cassidy JT. Methotrexate in juvenile rheumatoid arthritis: do the benefits outweigh the risks? Drug Saf 1993; 9: 325–39
Wallace CA, Sherry DD. Preliminary report of higher dose methotrexate treatment in juvenile rheumatoid arthritis. J Rheumatol 1992; 19: 1604–7
Reiff A, Shaham B, Wood BP, et al. High dose methotrexate in the treatment of refractory juvenile rheumatoid arthritis. Clin Exp Rheumatol 1995; 13: 113–8
Ravelli A, Gerloni V, Corona F, et al. Oral versus intramuscular methotrexate in juvenile chronic arthritis. Italian Pediatric Rheumatology Study Group. Clin Exp Rheumatol 1998; 16: 181–3
Wallace CA, Bleyer WA, Sherry DD, et al. Toxicity and serum levels of methotrexate in children with juvenile rheumatoid arthritis. Arthritis Rheum 1989; 32: 677–81
Wallace CA, Sherry DD. A practical approach to avoidance of methotrexate toxicity [editorial]. J Rheumatol 1995; 22: 1009–12
Albertioni F, Flato B, Seideman P, et al. Methotrexate in juvenile rheumatoid arthritis: evidence of age-dependent pharmacokinetics. Eur J Clin Pharmacol 1995; 47: 507–11
Hunt PG, Rose CD, McIlvain-Simpson G, et al. The effects of daily intake of folic acid on the efficacy of methotrexate therapy in children with juvenile rheumatoid arthritis: a controlled study. J Rheumatol 1997; 24: 2230–2
Martini A, Ravelli A, Viola S, et al. Methotrexate hepatotoxic effects in children with juvenile rheumatoid arthritis [letter]. J Pediatr 1991; 119: 333–4
Hashkes PJ, Balistreri WF, Bove KE, et al. The long-term effect of methotrexate therapy on the liver in patients with juvenile rheumatoid arthritis. Arthritis Rheum 1997; 40: 2226–34
Hashkes PJ, Balistreri WF, Bove KE, et al. The relationship of hepatotoxic risk factors and liver histology in methotrexate therapy for juvenile rheumatoid arthritis. J Pediatr 1999; 134: 47–52
Kremer JM, Alarcon GS, Lightfoot RWJ, et al. Methotrexate for rheumatoid arthritis. Suggested guidelines for monitoring liver toxicity. American College of Rheumatology. Arthritis Rheum 1994; 37: 316–28
Wallace CA, Smith AL, Sherry DD. Pilot investigation of naproxen/methotrexate interaction in patients with juvenile rheumatoid arthritis. J Rheumatol 1993; 20: 1764–8
Giannini EH, Ruperto N, Ravelli A, et al. Preliminary definition of improvement in juvenile arthritis. Arthritis Rheum 1997; 40: 1202–9
Ruperto N, Ravelli A, Falcini F, et al. Performance of the preliminary definition of improvement in juvenile chronic arthritis patients treated with methotrexate. Italian Pediatric Rheumatology Study Group. Ann Rheum Dis 1998; 57: 38–41
Ruperto N, Ravelli A, Falcini F, et al. Responsiveness of outcome measures in juvenile chronic arthritis. Italian Pediatric Rheumatology Study Group. Rheumatology (Oxford) 1999; 38: 176–80
Moroldo MB, Giannini EH. Estimates of the discriminant ability of definitions of improvement for juvenile rheumatoid arthritis. J Rheumatol 1998; 25: 986–9
Rose CD, Singsen BH, Eichenfield AH, et al. Safety and efficacy of methotrexate therapy for juvenile rheumatoid arthritis. J Pediatr 1990; 117: 653–9
Giannini EH, Cawkwell GD. Drug treatment in children with juvenile rheumatoid arthritis: past, present, and future. Pediatr Clin North Am 1995; 42: 1099–1125
Ravelli A, Viola S, Ramenghi B, et al. Radiologic progression in patients with juvenile chronic arthritis treated with methotrexate. J Pediatr 1998; 133: 262–5
Harel L, Wagner-Weiner L, Poznanski AK, et al. Effects of methotrexate on radiologic progression in juvenile rheumatoid arthritis. Arthritis Rheum 1993; 36: 1370–4
Gottlieb BS, Keenan GF, Lu T, et al. Discontinuation of methotrexate treatment in juvenile rheumatoid arthritis. Pediatrics 1997; 100: 994–7
Weiss AH, Wallace CA, Sherry DD. Methotrexate for resistant chronic uveitis in children with juvenile rheumatoid arthritis. J Pediatr 1998; 133: 266–8
Wallace CA. On beyond methotrexate treatment of severe juvenile rheumatoid arthritis. Clin Exp Rheumatol 1999; 17: 499–504
Grondin C, Malleson P, Petty RE. Slow-acting antirheumatic drugs in chronic arthritis of childhood. Semin Arthritis Rheum 1988; 18: 38–47
Rosenberg AM. Treatment of juvenile rheumatoid arthritis: approach to patients who fail standard therapy. J Rheumatol 1996; 23: 1652–6
Silverman ED, Miller JJ, Bernstein B, et al. Consumption coagulopathy associated with systemic juvenile rheumatoid arthritis. J Pediatr 1983; 103: 872–6
Jacobs JC, Gorin LJ, Hanissian AS, et al. Consumption coagulopathy after gold therapy for JRA [letter]. J Pediatr 1984; 105: 674–5
Manners PJ, Ansell BM. Slow-acting antirheumatic drug use in systemic onset juvenile chronic arthritis. Pediatrics 1986; 77: 99–103
Barash J, Cooper M, Tauber Z. Hepatic, cutaneous and hematologic manifestations in juvenile chronic arthritis. Clin Exp Rheumatol 1991; 9: 541–3
Prieur AM, Stephan JL. Macrophage activation syndrome in rheumatic diseases in children [in French]. Rev Rhum Ed Fr 1994; 61: 447–51
Grom AA, Passo M. Macrophage activation syndrome in systemic juvenile rheumatoid arthritis [editorial]. J Pediatr 1996; 129: 630–2
Houpt JB. A rheumatologist’s verdict on the safety of chloroquine versus hydroxychloroquine: liability in Off-label prescribing. J Rheumatol 1999; 26: 1864–6
Easterbrook M. An opthalmological view on the efficacy and safety of chloroquine versus hydroxychloroquine. J Rheumatol 1999; 26: 1866–7
Esdaile JM. More thoughts about antimalarials: should one prescribe chloroquine? J Rheumatol 1999; 26: 1868
Laaksonen AL, Koskiahde V, Juva K. Dosage of antimalarial drugs for children with juvenile rheumatoid arthritis and systemic lupus erythematosus: a clinical study with determination of serum concentrations of chloroquine and hydroxychloroquine. Scand J Rheumatol 1974; 3: 103–8
Brewer EJ, Giannini EH, Kuzmina N, et al. Penicillamine and hydroxychloroquine in the treatment of severe juvenile rheumatoid arthritis: results of the U.S.A.-U.S.S.R. double-blind placebo-controlled trial. N Engl J Med 1986; 314: 1269–76
Hamilton EBD, Scott JT. Hydroxychloroquine sulfate (‘Plaquenil’) in treatment of rheumatoid arthritis. Arthritis Rheum 1962; 5: 502–12
Markowitz HA, McGinley JM. Chloroquine poisoning in a child. JAMA 1964; 189: 950–1
Sassaman FW, Cassidy JT, Alpern M, et al. Electroretinography in patients with connective tissue diseases treated with hydroxychloroquine. Am J Ophthalmol 1970; 70: 515–23
Maksymowych W, Russell AS. Antimalarials in rheumatology: efficacy and safety. Semin Arthritis Rheum 1987; 16: 206–21
Rynes RI. Ophthalmologic considerations in using antimalarials in the United States. Lupus 1996; 5 Suppl. 1: S73–4
Rynes RI. Antimalarial drugs in the treatment of rheumatological diseases. Br J Rheumatol 1997; 36: 799–805
Stillman JS. Antimalarials in the treatment of juvenile rheumatoid arthritis. In: Moore TD, editor. Arthritis in childhood: report of the Eightieth Ross Conference in Pediatric Research. Columbus, Ohio: Ross Laboratories, 1981: 125
Van Kerckhove C, Giannini EH, Lovell DJ. Temporal patterns of response to D-penicillamine, hydroxychloroquine, and placebo in juvenile rheumatoid arthritis patients. Arthritis Rheum 1988; 31: 1252–8
Sairanen E, Laaksonen AL. The toxicity of gold therapy in children suffering from rheumatoid arthritis. Ann Paediatr Fenn 1962; 8: 105
Sairanen E, Laaksonen AL. The results of gold therapy in juvenile rheumatoid arthritis. Ann Paediatr Fenn 1963; 10: 274
Hicks RM, Hanson V, Kornreich HK. The use of gold in the treatment of juvenile rheumatoid arthritis [abstract]. Arthritis Rheum 1970; 13: 323
Debendetti C, Tretbar H, Corrigan JJJ. Gold therapy in juvenile rheumatoid arthritis. Ariz Med 1976; 33: 373–6
Levinson JE, Balz GP, Bondi S. Gold therapy. Arthritis Rheum 1977; 20: 531–5
Makela AL, Peltola O, Makela P. Gold serum levels in children with juvenile rheumatoid arthritis. Scand J Rheumatol 1978; 7: 161–5
Brewer EJJ, Giannini EH, Barkley E. Gold therapy in the management of juvenile rheumatoid arthritis. Arthritis Rheum 1980; 23: 404–11
Ansell BM, Hall MA, Ribero S. A comparative study of gold and penicillamine in seropositive juvenile chronic arthritis (juvenile rheumatoid arthritis) [abstract]. Ann Rheum Dis 1981; 40: 522
Ansell BM, Hall MA. Penicillamine in chronic arthritis of childhood. J Rheumatol Suppl 1981; 7: 112–5
Kvien TK, Hoyeraal HM, Sandstad B. Gold sodium thiomalate and D-penicillamine: a controlled, comparative study in patients with pauciarticular and polyarticular juvenile rheumatoid arthritis. Scand J Rheumatol 1985; 14: 346–54
Research Subcommittee of the Empire Rheumatism Council. Gold therapy in rheumatoid arthritis: final report of a multi-centre controlled trial. Ann Rheum Dis 1961; 20: 315–33
Kvien TK, Hoyeraal HM, Sandstad B. Slow acting antirheumatic drugs in patients with juvenile rheumatoid arthritis: evaluated in a randomized, parallel 50-week clinical trial. J Rheumatol 1985; 12: 533–9
Adachi JD, Bensen WG, Kassam Y, et al. Gold-induced throm-bocytopenia: 12 cases and a review of the literature. Semin Arthritis Rheum 1987; 16: 287–93
Amos RS, Bax DE. Leucopenia in rheumatoid arthritis: relationship to gold or sulphasalazine therapy. Br J Rheumatol 1988; 27: 465–8
Giannini EH, Brewer EJJ, Kuzmina N, et al. Auranofin in the treatment of juvenile rheumatoid arthritis: results of the USA-USSR double-blind, placebo-controlled trial. The USA Pediatric Rheumatology Collaborative Study Group. The USSR Cooperative Children’s Study Group. Arthritis Rheum 1990; 33: 466–76
Ansell BM, Hall MA, Loftus JK, et al. A multicentre pilot study of sulphasalazine in juvenile chronic arthritis. Clin Exp Rheumatol 1991; 9: 201–3
Ozdogan H, Turunc M, Deringol B, et al. Sulphasalazine in the treatment of juvenile rheumatoid arthritis: a preliminary open trial. J Rheumatol 1986; 13: 124–5
van Rossum MA, Fiselier TJ, Franssen MJ, et al. Sulfasalazine in the treatment of juvenile chronic arthritis: a randomized, double-blind, placebo-controlled, multicenter study. Dutch Juvenile Chronic Arthritis Study Group. Arthritis Rheum 1998; 41: 808–16
Schairer H, Stoeber E. Long-term follow-up of 235 cases of juvenile rheumatoid arthritis treated with D-penicillamine. In: Munthe E, editor. Penicillamine research in rheumatoid disease. Oslo: Fabricius and Sonner, 1977: 279–81
Prieur AM, Piussan C, Manigne P, et al. Evaluation of D-penicillamine in juvenile chronic arthritis: a double-blind, multi-center study. Arthritis Rheum 1985; 28: 376–82
Enzenauer RJ, West SG, Rubin RL. D-penicillamine-induced lupus erythematosus. Arthritis Rheum 1990; 33: 1582–5
Wooley PH, Griffin J, Panayi GS, et al. HLA-DR antigens and toxic reaction to sodium aurothiomalate and D-penicillamine in patients with rheumatoid arthritis. N Engl JMed 1980; 303: 300–2
Groothoff JW, van Leeuwen EF. High dose intravenous gamma-globulin in chronic systemic juvenile arthritis. Br Med J (Clin Res Ed) 1988; 296: 1362–3
Stein LD, Roifman CM. Intravenous immunoglobulin therapy. Bull Rheum Dis 1995; 44: 3–5
Prieur AM. Intravenous immunoglobulins in Still’s disease: still controversial, still unproven [editorial]. J Rheumatol 1996; 23: 797–800
Silverman ED, Cawkwell GD, Lovell DJ, et al. Intravenous immunoglobulin in the treatment of systemic juvenile rheumatoid arthritis: a randomized, placebo-controlled trial. Pediatric Rheumatology Collaborative Study Group. J Rheumatol 1994; 21: 2353–8
Silverman ED, Laxer RM, Greenwald M, et al. Intravenous gamma globulin therapy in systemic juvenile rheumatoid arthritis. Arthritis Rheum 1990; 33: 1015–22
Uziel Y, Laxer RM, Schneider R, et al. Intravenous immunoglobulin therapy in systemic onset juvenile rheumatoid arthritis: a follow-up study. J Rheumatol 1996; 23: 910–8
Prieur AM, Adleff A, Debre M, et al. High dose immunoglobulin therapy in severe juvenile chronic arthritis: long-term follow-up in 16 patients. Clin Exp Rheumatol 1990; 8: 603–8
Giannini EH, Lovell DJ, Silverman ED, et al. Intravenous immunoglobulin in the treatment of polyarticular juvenile rheumatoid arthritis: a phase I/II study. Pediatrie Rheumatology Collaborative Study Group. J Rheumatol 1996; 23: 919–24
Myers BD, Ross J, Newton L, et al. Cyclosporine-associated chronic nephropathy. N Engl J Med 1984; 311: 699–705
Palestine AG, Austin HA, Balow JE, et al. Renal histopathologic alterations in patients treated with cyclosporine for uveitis. N Engl J Med 1986; 314: 1293–8
van den Borne BE, Landewe RB, Houkes I, et al. No increased risk of malignancies and mortality in cyclosporin A-treated patients with rheumatoid arthritis. Arthritis Rheum 1998; 41: 1930–7
Bjerkhoel F, Forre O. Cyclosporin treatment of a patient with severe systemic juvenile rheumatoid arthritis. Scand J Rheumatol 1988; 17: 483–6
Ostensen M, Hoyeraal HM, Kass E. Tolerance of cyclosporine A in children with refractory juvenile rheumatoid arthritis. J Rheumatol 1988; 15: 1536–8
Reiff A, Rawlings DJ, Shaham B, et al. Preliminary evidence for cyclosporin A as an alternative in the treatment of recalcitrant juvenile rheumatoid arthritis and juvenile dermatomyositis. J Rheumatol 1997; 24: 2436–43
Mouy R, Stephan JL, Pillet P, et al. Efficacy of cyclosporine A in the treatment of macrophage activation syndrome in juvenile arthritis: report of five cases. J Pediatr 1996; 129: 750–4
Laaksonen AL, Sunell JE, Westeren H, et al. Adrenocortical function in children with juvenile rheumatoid arthritis and other connective tissue disorders. Scand J Rheumatol 1974; 3: 137–42
Schaller JG. Corticosteroids in juvenile rheumatoid arthritis. Arthritis Rheum 1977; 20: 537–43
Stoeber E. Juvenile chronic polyarthritis and Still’s syndrome. Doc Geigy 1977; 1
Prieur AM. The place of corticosteroid therapy in juvenile chronic arthritis in 1992. J Rheumatol Suppl 1993; 37: 32–4
Southwood TR. Report from a symposium on corticosteroid therapy in juvenile chronic arthritis. Clin Exp Rheumatol 1993; 11: 91–4
Axelrod L. Glucocorticoid therapy. Medicine (Baltimore) 1976; 55: 39–65
Slocumb CH. Relative cortisone deficiency simulating exacerbation of arthritis. Bull Rheum Dis 1952; 3: 21
Miller JJ. Prolonged use of large intravenous steroid pulses in the rheumatic diseases of children. Pediatrics 1980; 65: 989–94
Oppermann J, Mobius D. Therapeutical and immunological effects of methylprednisolone pulse therapy in comparison with intravenous immunoglobulin: treatment in patients with juvenile chronic arthritis. Acta Univ Carol [Med] (Praha) 1994; 40: 117–21
Adebajo AO, Hall MA. The use of intravenous pulsed methylprednisolone in the treatment of systemic-onset juvenile chronic arthritis. Br J Rheumatol 1998; 37: 1240–2
Klein-Gitelman MS, Pachman LM. Intravenous corticosteroids: adverse reactions are more variable than expected in children. J Rheumatol 1998; 25: 1995–2002
Kanski JJ. Anterior uveitis in juvenile rheumatoid arthritis. Arch Ophthalmol 1977; 95: 1794–7
Allen RC, Gross KR, Laxer RM, et al. Intraarticular triamcinolone hexacetonide in the management of chronic arthritis in children. Arthritis Rheum 1986; 29: 997–1001
Earley A, Cuttica RJ, McCullough C, et al. Triamcinolone into the knee joint in juvenile chronic arthritis. Clin Exp Rheumatol 1988; 6: 153–5
Sparling M, Malleson P, Wood B, et al. Radiographic followup of joints injected with triamcinolone hexacetonide for the management of childhood arthritis. Arthritis Rheum 1990; 33: 821–6
Job-Deslandre C, Menkes CJ. Complications of intra-articular injections of triamcinolone hexacetonide in chronic arthritis in children. Clin Exp Rheumatol 1990; 8: 413–6
Hertzberger-ten CR, Cats A. Toxicity of sulfasalazine in systemic juvenile chronic arthritis. Clin Exp Rheumatol 1991; 9: 85–8
Dent PB, Walker N. Intra-articular corticosteroids in the treatment of juvenile rheumatoid arthritis. Curr Opin Rheumatol 1998; 10: 475–80
Kvien TK, Hoyeraal HM, Sandstad B. Azathioprine versus placebo in patients with juvenile rheumatoid arthritis: a single center double-blind comparative study. J Rheumatol 1986; 13: 118–23
Savolainen HA, Kautiainen H, Isomaki H, et al. Azathioprine in patients with juvenile chronic arthritis: a longterm follow-up study. J Rheumatol 1997; 24: 2444–50
Shaikov AV, Maximov AA, Speransky AI, et al. Repetitive use of pulse therapy with methylprednisolone and cyclophosphamide in addition to oral methotrexate in children with systemic juvenile rheumatoid arthritis: preliminary results of a long term study. J Rheumatol 1992; 19: 612–6
Lehman TJ. Aggressive therapy for childhood rheumatic diseases: when are immunosuppressives appropriate? Arthritis Rheum 1993; 36: 71–4
Wallace CA, Sherry DD. Trial of intravenous pulse cyclophos-phamide and methylprednisolone in the treatment of severe systemic-onset juvenile rheumatoid arthritis. Arthritis Rheum 1997; 40: 1852–5
Savolainen HA, Isomaki HA. Decrease in the number of deaths from secondary amyloidosis in patients with juvenile rheumatoid arthritis. J Rheumatol 1993; 20: 1201–3
Ansell BM. Chlorambucil therapy in juvenile chronic arthritis (juvenile idiopathic arthritis). [editorial] J Rheumatol 1999; 26: 765–6
Laxer RM. Long-term toxicity of immune suppression in juvenile rheumatic diseases. Br J Rheumatol 1999; 38: 743–6
Prieur AM, Balafrej M, Griscelli C, et al. Results and long-term risks of immuno-suppressive treatment in chronic juvenile arthritis: apropos of 40 cases [in French]. Rev Rhum Mal Osteoartic 1979; 46: 85–90
Buriot D, Prieur AM, Lebranchu Y, et al. Acute leukemia in 3 children with chronic juvenile arthritis treated with chlorambucil [in French]. Arch Fr Pediatr 1979; 36: 592–8
Ansell BM, Eghtedari A, Bywaters EG. Chlorambucil in the management of juvenile chronic polyarthritis complicated by amyloidosis. Ann Rheum Dis 1971; 30: 331
Deschenes G, Prieur AM, Hayem F, et al. Renal amyloidosis in juvenile chronic arthritis: evolution after chlorambucil treatment. Pediatr Nephrol 1990; 4: 463–9
Rostropowicz-Denisiewicz K. Some remarks on management of juvenile chronic arthritis complicated by amyloidosis. Acta Univ Carol [Med] (Praha) 1994; 40: 91–4
Savolainen HA. Chlorambucil in severe juvenile chronic arthritis: long term follow-up with special reference to amyloidosis. J Rheumatol 1999; 26: 898–903
Weaver A, Caldwell J, Olsen N. Treatment of active rheumatoid arthritis with leflunomide compared to placebo or methotrexate. Arthritis Rheum 1998; 41: S131
Rozman B. Clinical experience with leflunomide in rheumatoid arthritis. Leflunomide Investigators’ Group. J Rheumatol Suppl 1998; 53: 27–32
Weinblatt ME, Kremer JM, Coblyn JS, et al. Pharmacokinetics, safety, and efficacy of combination treatment with methotrexate and leflunomide in patients with active rheumatoid arthritis. Arthritis Rheum 1999; 42: 1322–8
Lovell DJ, Giannini EH, Whitmore JB, et al. Safety and efficacy of tumor necrosis factor receptor P75 FC fusion protein (TNFR: FC; Enbrel TM) in polyarticular course juvenile rheumatoid arthritis [abstract]. Arthritis Rheum 1998; 41 (Suppl.): S130
Keystone EC. The role of tumor necrosis factor antagonism in clinical practice. J Rheumatol 1999; 26 Suppl. 57: 22–8
Moreland LW. Inhibitors of tumor necrosis factor for rheumatoid arthritis. J Rheumatol 1999; 26 Suppl. 57: 7–15
Moreland LW, Schiff MH, Baumgartner SW, et al. Etanercept therapy in rheumatoid arthritis: a randomized, controlled trial. Ann Intern Med 1999; 130: 478–86
Weinblatt ME, Kremer JM, Bankhurst AD, et al. A trial of etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med 1999; 340: 253–9
Jones RE, Moreland LW. Tumor necrosis factor inhibitors for rheumatoid arthritis. Bull Rheum Dis 1999; 48: 1–4
Elliott MJ, Maini RN, Feldmann M, et al. Randomised double-blind comparison of chimeric monoclonal antibody to tumour necrosis factor alpha (cA2) versus placebo in rheumatoid arthritis. Lancet 1994; 344: 1105–10
Elliott MJ, Maini RN, Feldmann M, et al. Repeated therapy with monoclonal antibody to tumour necrosis factor alpha (cA2) in patients with rheumatoid arthritis. Lancet 1994; 344: 1125–7
Maini RN, Elliott M, Brennan FM, et al. Targeting TNF alpha for the therapy of rheumatoid arthritis. Clin Exp Rheumatol 1994; 12 Suppl. 11: S63–6
Elliott MJ, Woo P, Charles P, et al. Suppression of fever and the acute-phase response in a patient with juvenile chronic arthritis treated with monoclonal antibody to tumour necrosis factor-alpha (cA2). Br J Rheumatol 1997; 36: 589–93
Maini RN, Breedveld FC, Kalden JR, et al. Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor alpha monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis. Arthritis Rheum 1998; 41: 1552–63
Choy EH, Kingsley GH, Panayi GS. Monoclonal antibody therapy in rheumatoid arthritis. Br J Rheumatol 1998; 37: 484–490
Rau R, Sander O, den Breeder A, et al. Long-term efficacy and tolerability of multiple I.V. doses of a fully human anti-TNF-antibody D2E7 in patients with rheumatoid arthritis. Arthritis Rheum 1998; 41: S55
Wulffraat N, van Royen A, Bierings M, et al. Autologous haemopoietic stem-cell transplantation in four patients with refractory juvenile chronic arthritis. Lancet 1999; 353: 550–3
Quartier P, Prieur AM, Fischer A. Haemopoietic stem-cell transplantation for juvenile chronic arthritis [letter]. Lancet 1999; 353: 1885–6
Kuis W, Wulffraat NM, Petty RE. Autologous stem cell transplantation: an alternative for refractory juvenile chronic arthritis. Br J Rheumatol 1999; 38: 737–8
Wulffraat NM, Kuis W Autologous stem cell transplantation: a possible treatment for refractory juvenile chronic arthritis? Br J Rheumatol 1999; 38: 764–6
Wulffraat NM, Kuis W, Petty R. Addendum: proposed guidelines for autologous stem cell transplantation in juvenile chronic arthritis. Br J Rheumatol 1999; 38: 777–8
Johansson U, Portinsson S, Akesson A, et al. Nutritional status in girls with juvenile chronic arthritis. Hum Nutr Clin Nutr 1986; 40: 57–67
Mortensen AL, Allen JR, Allen RC. Nutritional assessment of children with juvenile chronic arthritis. J Paediatr Child Health 1990; 26: 335–8
Henderson CJ, Lovell DJ, Specker BL, et al. Physical activity in children with juvenile rheumatoid arthritis: quantification and evaluation. Arthritis Care Res 1995; 8: 114–9
Henderson CJ, Lovell DJ. Nutritional aspects of juvenile rheumatoid arthritis. Rheum Dis Clin North Am 1991; 17: 403–13
Knops N, Wulffraat N, Lodder S, et al. Resting energy expenditure and nutritional status in children with juvenile rheumatoid arthritis. J Rheumatol 1999; 26: 2039–43
Rapoff MA, Purviance MR, Lindsley CB. Educational and behavioral strategies for improving medication compliance in juvenile rheumatoid arthritis. Arch Phys Med Rehabil 1988; 69: 439–41
Donovan WH. Physical measures in the treatment of juvenile rheumatoid arthritis. Arthritis Rheum 1977; 20: 553–7
Scull SA, Dow MB, Athreya BH. Physical and occupational therapy for children with rheumatic diseases. Pediatr Clin North Am 1986; 33: 1053–77
Emery HM, Kucinski J. Management of juvenile rheumatoid arthritis: a handbook for occupational and physical therapists. Chicago (IL): LaRabida Children’s Hospital and Research Center, 1987
Fan JS, Wessel J, Ellsworth J. The relationship between strength and function in females with juvenile rheumatoid arthritis. J Rheumatol 1998; 25: 1399–405
Hackett J, Johnson B, Parkin A, et al. Physiotherapy and occupational therapy for juvenile chronic arthritis: custom and practice in five centres in the UK, USA and Canada. Br J Rheumatol 1996; 35: 695–9
Petty RE. Prognosis in children with rheumatic diseases: justification for consideration of new therapies. Br J Rheumatol 1999; 38: 739–42
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cassidy, J.T. Medical Management of Children with Juvenile Rheumatoid Arthritis. Drugs 58, 831–850 (1999). https://doi.org/10.2165/00003495-199958050-00006
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-199958050-00006