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Clinical Question:
What medical treatments are effective in the management of juvenile
idiopathic arthritis?
Bottom Line:
Nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular injections of
corticosteroids, methotrexate, and possibly biologic-modifiers are somewhat
beneficial in the management of juvenile idiopathic arthritis (JIA),
particularly oligoarthritis. Patients with polyarthritis and a positive
rheumatoid factor respond poorly to medications and require aggressive
individual management.
Reference:
Hashkes PJ, Laxer RM. Medical treatment of juvenile idiopathic arthritis.
JAMA 2005;294:1671-84.
Study Design:
Systematic review
Funding:
Self-funded or unfunded
Setting:
Various (meta-analysis)
Synopsis:
The treatment of juvenile idiopathic arthritis (JIA) has changed markedly in
the last 15 years. Many children with JIA are not treated by pediatric
rheumatologists. To review the best evidence for the treatment of JIA.
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. Randomized controlled trials
and open studies including at least 10 patients for medications without
controlled trials. 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. 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. |