Diagnosis and management of pediatric rheumatic diseases has changed markedly in the past decade. Paediatric rheumatic diseases differ significant from their adult counterpart. For instance the ILAR classification of Juvenile Idiopathic Arthritis has 7 subtypes. Only the RF positive JIA subtype, accounting for just 5-7% of JIA cases, closely resembles adult RA. The most prevalent subtypes are poly articular RF negative JIA (28%) and oligoarticular JIA (30—56%). Stills disease is very rare in adults whereas it accounts for 10-20% paediatric cases. Treatment algorithms are subtype specific. In contrast to RA, JIA is often self limiting, especially the oligoarticular subtype. Treatment aims at early recognition and adequate suppression of inflammation followed by efforts of tapering the medication used. For instance in about 50% of children with JIA, MTX can be stopped successfully. Biomarkers of a specific clinical course under MTX treatment are however lacking. Criteria for inactive disease on/off medication have been defined, and recently detailed recommendations for treatment including biologics were published by a combined US-European task force. For JIA biologics such as etanercept, adalimumab and abatacept are registered for JIA, whereas registration of tociluzimab and cankinumab will soon be registered for use in systemic onset JIA (SJIA). Anakinra is used off label for S-JIA. Indications for treatment and evaluation of efficacy will be discussed. Key issue in treatment algorithms is identification of risk factors and lack of response to previous therapies. Similar to early arthritis treatment strategies in RA, high risk JIA (poly JIA, SJIA) should be recognised and treated early. There appears to be a window of opportunity created by early aggressive treatment inducing remission followed by tapering of medication. Experience with the use of biologics in JIA is relatively recent and we should be vigilant of possible unknown long term side effects. To this purpose a European pharmacovigilance initiative called PharmaChild was recently launched.
Disclosure of Interest None Declared