| Abstract: | Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatological disease of childhood. Despite the current availability of potent disease-modifying anti-rheumatic medications, most children still experience a chronic course with prolonged periods of active disease. Goals for treatment should include disease remission with optimal physical functioning allowing children to lead normal lives without structural joint damage. However, recent studies demonstrate only moderate rates of remission, indicating that JIA is not as benign as previously thought. The probability of attaining remission within 5 years is approximately 50% across all JIA categories except for polyarthritis when the outlook is significantly worse. Longer term, about 50% of adults with JIA suffer from persistent inflammation and disability.There is a shift towards early aggressive treatment with the intention to switch off inflammation since there may be a ‘window of opportunity’ before the disease becomes chronic. There is clear evidence for improved outcome in adult patients treated with this approach (‘treat to target’) but limited paediatric evidence to date. The explosion in anticytokine agents for treatment of disease resistant to conventional therapy has expanded our armamentarium, improving short term clinical outcomes, but it is still unclear whether we have achieved significant improvements in outcome longer term. This review describes the disease and current and longer-term data on outcomes for this common chronic childhood condition. |
