Context The treatment of juvenile idiopathic arthritis (JIA) has changed markedly
in the last 15 years. Many children with JIA are not treated by pediatric
Objective To review the best evidence for the treatment of JIA.
Data Sources English-language trials of JIA between 1966 and 2005 were searched using
MEDLINE, EMBASE, the Cochrane database, and abstracts from recent rheumatology
and pediatric scientific meetings.
Study Selection Randomized controlled trials and open studies including at least 10
patients for medications without controlled trials.
Data Extraction For studies after 1997, the American College of Rheumatology Pediatric
30 outcome measure was used to define patients as responders. For older studies,
the primary response outcome measure defined by the authors was used.
Data Synthesis Thirty-four controlled studies were identified. Nonsteroidal anti-inflammatory
drugs are effective only for a minority of patients, mainly those with oligoarthritis.
Intra-articular corticosteroid injections are very effective for oligoarthritis.
Methotrexate is effective for the treatment of extended oligoarthritis and
polyarthritis and less effective for systemic arthritis. Sulfasalazine and
leflunomide may be alternatives to methotrexate. Antitumor necrosis factor
medications are highly effective for polyarticular course JIA not responsive
to methotrexate but are less effective in systemic arthritis. There is a lack
of evidence for the optimal treatment of systemic and enthesitis-related arthritis.
Conclusions Despite many advances in the treatment of JIA, there is still a lack
of evidence for treatment of several disease subtypes. The treatment plan
needs to be individualized based on the JIA subtype.