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Polyarticular juvenile idiopathic arthritis: Treatment

Author
Pamela F Weiss, MD, MSCE
Section Editor
Marisa Klein-Gitelman, MD, MPH
Deputy Editor
Elizabeth TePas, MD, MS

INTRODUCTION

Polyarticular juvenile idiopathic arthritis (formerly called polyarticular onset juvenile rheumatoid arthritis [RA]) is a subset of juvenile idiopathic arthritis (JIA) that is defined by the presence of more than four affected joints during the first six months of illness [1]. In the revised nomenclature, this disease, which comprises 20 to 30 percent of patients with JIA, is included in the group termed "childhood polyarthritis." (See "Classification of juvenile arthritis".)

Therapy is directed toward treating the underlying inflammation of JIA and preventing complications associated with JIA (eg, joint damage) or the adverse effects of its treatment [2]. Medications used in the treatment of polyarticular JIA have various mechanisms of action, some of which are unknown, but all suppress inflammation. First-line agents include nonsteroidal anti-inflammatory agents (NSAIDs) and nonbiologic disease-modifying antirheumatic drugs (DMARDs) such as methotrexate. Second-line drugs referred to as biologic DMARDs include anti-tumor necrosis factor-alpha (TNF-alpha) agents.

Although many parents and clinicians voice fear of potential side effects from medications, years of experience make it clear that there is far more to fear from the damage known to be caused by ongoing joint inflammation. The belief statement that children often "grow out of JIA" is incorrect and may lead to delays in appropriate therapy and poor outcomes. It is essential that clinicians make families aware of the fact that children with polyarticular JIA are unlikely to outgrow their disease since this myth may heavily influence the family’s understanding of the risk-to-benefit ratio of medications.

The treatment of polyarticular JIA is reviewed here. The clinical manifestations, diagnosis, complications, and prognosis of polyarticular JIA are discussed separately. (See "Polyarticular juvenile idiopathic arthritis: Clinical manifestations, diagnosis, and complications".)

MANAGEMENT APPROACH

The approach to the treatment of polyarticular juvenile idiopathic arthritis (JIA) is reviewed here and is consistent with the approach outlined in the 2011 American College of Rheumatology (ACR) Juvenile Arthritis Treatment Recommendations [2]. One exception is that the biologic agents (tumor necrosis factor [TNF] inhibitors) are increasingly used earlier in the treatment course and for less severe disease. The specific agents are discussed in detail separately or in the sections below. (See "NSAIDs: Mechanism of action" and 'Methotrexate' below and 'Tumor necrosis factor (TNF) inhibitors' below.)

                                          

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Literature review current through: Nov 2016. | This topic last updated: Wed Dec 09 00:00:00 GMT+00:00 2015.
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