Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disorder in children and is also a major cause of acquired disability and quality of life impairment in childhood. Children with oligoarticular JIA are usually treated with NSADS and intraarticular steroid injections. For children with polyarticular course JIA, methotrexate (MTX) is the drug of first choice since it provides significant clinical benefits, with an acceptable toxicity profile. For children not responding to MTX, the introduction of the biologic agents has determined a substantial advantage for the therapy of JIA since for the first time we have now drugs able to selectively block key components of the inflammation cascade.
Biologic agents can be globally divided into 2 categories: drugs able to block the tumor necrosis factor (TNF) (etanercept, infliximab, adalimumab and others) and drugs with different mechanism of action (eg abatacept, tocilizumab, anakinra, canakinumab ecc). In general biologic agents, also for their elevated cost, have to administered in children with severe arthritis non responsive to conventional therapies, primarily MTX.
The real novelty in these last years, has been the availability of biologic agents to be specifically used for the treatment of systemic JIA where, along with arthritis, children have systemic manifestations such as fever, rash, serositis, lymphadenopathy etc. These new drugs are indeed able to block selectively molecules that has been shown to be pivotal in the inflammatory process such as IL6 (tocilizumab) and IL 1 (anakinra, canakinumab and others)
Most of the biologic agents have been tested (or are currently under study) thanks to the involvement of the Pediatric Rheumatology International Trials Organisation (PRINTO at www.printo.it) and of the Paediatric Rheumatology Collaborative Study Group (PRCSG at www.prcsg.org).
This review will present a practically orientated overview of the “state of the art” for the treatment of JIA and the other major paediatric rheumatic disases including an overview on safety aspects.
Disclosure of Interest N. Ruperto Grant/research support from: The Gaslini Hospital, which is the public Hospital where I work as full time public employee, has received contributions from the following industries: Abbott, BMS, “Francesco Angelini”, GlaxoSmithKline (GSK), Hoffman-La Roche, Italfarmaco, Janssen, Novartis, Pfizer, Sanofi Aventis, Schwarz Biosciences, Sobi, Xoma, Wyeth. This money has been reinvested for the research activities of the hospital in a fully independent manners besides any committment with third parties., Speakers bureau: The undersigned Dr Nicolino Ruperto received honoraria for consultancy or speaker's bureau from the following pharmaceutical companies: Abbott, AbbVie, Amgen, Biogenidec, Astellas, Alter, AstraZeneca, Boehringer, BMS, CD-Pharma,Celgene, CrescendoBio, EMD Serono,Hoffman-La Roche, Italfarmaco, Janssen, MedImmune, Medac, Novartis, Novo Nordisk, Pfizer, Sanofi Aventis, Servier, Takeda, Vertex.