Inflammatory rheumatism is one of the leading causes of chronic diseases in childhood. Over the last two decades, major changes in the treatment strategies of the paediatric patients have led to a significant improvement in control of inflammation, outcome and quality of life. The main rheumatologic inflammatory condition in children and adolescents is Juvenile Idiopathic Arthritis (JIA), a group of 7 different diagnostic categories.
Treatment of JIA is usually initiated with non-steroidal anti-inflammatory drugs. In case of oligoarticular involvement, steroid joint injection is the favoured therapy, and polyarticular JIA will be treated by methotrexate. TNF blocking agents (etanercept and adalimumab) and selective costimulation modulator (abatacept) are the first line biological agents for JIA with polyarticular involvement. For systemic-onset JIA, the paediatric form of Still's disease, IL-1 and IL-6 blocking agents have recently demonstrated highly efficacious to control both systemic and joint inflammation. Despite recent trials, a number of new molecules are still used off-label in children. Furthermore, many inflammatory rheumatisms in children are rare diseases, and only few or even no new treatments have been registered for these indications.
Biological agents are well tolerated in paediatric patients, but long-term safety of these drugs is still unknown. Cohorts of paediatric patients treated by DMARDs and/or biological agents are needed to assess safety and efficacy of the new therapies into adulthood.
Two specific aspects of paediatric management are the high prevalence of asymptomatic uveitis, for which a regular screening should be performed, and the need for a structured transition to adulthood.
Disclosure of Interest M. Hofer Grant/Research support from: Novartis, Pfizer, Abbvie, Consultant for: Novartis