Juvenile idiopathic arthritis is the most common chronic
rheumatic disease of unknown aetiology in childhood and predominantly presents with peripheral
arthritis. The disease is divided into several subgroups, according to demographic characteristics, clinical features, treatment modalities and disease prognosis. Systemic
juvenile idiopathic arthritis, which is one of the most frequent disease subtypes, is characterized by recurrent
fever and
rash. Oligoarticular
juvenile idiopathic arthritis, common among young female patients, is usually accompanied by anti-nuclear antibodie positivity and
anterior uveitis. Seropositive
polyarticular juvenile idiopathic arthritis, an analogue of adult
rheumatoid arthritis, is seen in less than 10% of paediatric patients. Seronegative
polyarticular juvenile idiopathic arthritis, an entity more specific for childhood, appears with widespread large- and small-joint involvement. Enthesitis-related
arthritis is a separate disease subtype, characterized by enthesitis and asymmetric lower-extremity
arthritis. This disease subtype represents the childhood form of adult
spondyloarthropathies, with human leukocyte antigen-B27 positivity and
uveitis but commonly without axial skeleton involvement.
Juvenile psoriatic arthritis is characterized by a psoriatic
rash, accompanied by
arthritis, nail pitting and dactylitis. Disease complications can vary from growth retardation and
osteoporosis secondary to treatment and disease activity, to life-threatening
macrophage activation syndrome with multi-organ insufficiency. With the advent of new
therapeutics over the past 15 years, there has been a marked improvement in
juvenile idiopathic arthritis treatment and long-term outcome, without any sequelae. The treatment of
juvenile idiopathic arthritis patients involves teamwork, including an experienced paediatric rheumatologist, an ophthalmologist, an orthopaedist, a paediatric psychiatrist and a physiotherapist. The primary goals of treatment are to eliminate active disease, to normalize joint function, to preserve normal growth and to prevent long-term joint damage. Timely and aggressive treatment is important to provide early disease control. The first-line treatment includes disease-modifying
anti-rheumatic drugs (
methotrexate,
sulphasalazine,
leflunomide) in combination with
corticosteroids, used in different dosages and routes (oral, intravenous, intra-articular). Intra-articular application of
steroids seems to be an effective treatment modality, especially in monoarthritis.
Biological agents should be added in the treatment of unresponsive patients. Anti-tumour
necrosis factor agents (
etanercept,
infliximab,
adalimumab), anti-interleukin-1 agents (
anakinra,
canakinumab), anti-
interleukin-6 agents (
tocilizumab) and T-cell regulatory agents (
abatacept) have been shown to be safe and effective in childhood patients. Recent studies reported sustained reduction in joint damage with even complete clinical improvement in paediatric patients, compared to previous data.