Description
The management of juvenile idiopathic arthritis (JIA) must be rigorous, aiming for disease control. The long-term outlook is often good, but factors leading to a poor functional outcome include the severity of arthritis score at onset and the cumulative duration of active disease. Early use of methotrexate is now included in the British Paediatric Rheumatology Group algorithms for treatment.
Whereas methotrexate, and other disease modifying and immuno-suppressive drugs are frequently employed, either alone or in combination, many of these drugs are neither licensed for use in children, nor have been subjected to randomised controlled trials. Despite all efforts systemic disease may remain refractory to even high dose drug regimes; anti-TNF alpha therapy and autologous stem cell transplantation are now being evaluated.
