ABSTRACT
Although the overall prognosis for most children with chronic arthritis is good, a small proportion of children with systemic onset or polyarticular Juvenile Idiopathic Arthritis (JIA) are refractory to combinations of non-steroidal anti-inflammatory drugs (NSAIDS) and immunosuppressive drugs such as methotrexate (MTX), cyclosporin (CsA), and prednisone. 1-4 Such children often have severe joint destruction, growth retardation and adverse drug effects from long-term treatment with second-line anti-rheumatic drugs. In the evaluation of new treatments, one needs to balance a possible significant improvement of the quality of life with risk of severe side effects. Recently, the introduction of anti-Tumor Necrosis Factor receptor (TNF-r) treatment has had a major impact on outcome of children with polyarticular JIA who were unresponsive to methotrexate, with a persistent response of up to 80%.5 Use of anti-TNF-r treatment in children with systemic disease has been discussed extensively at several Pediatric Rheumatology meetings and the general impression (reflecting experience in some 40 patients with systemic JIA, treated for more than 4 months) is that, in active systemic disease this treatment is less effective with a clear response in a minority of patients only.
