Clinical Review

Diagnosis and management of juvenile idiopathic arthritis

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c6434 (Published 03 December 2010) Cite this as: BMJ 2010;341:c6434
  1. Femke H M Prince, research fellow (paediatric) rheumatology12,
  2. Marieke H Otten, PhD student paediatric rheumatology1,
  3. Lisette W A van Suijlekom-Smit, paediatric rheumatologist1
  1. 1Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
  2. 2Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
  1. Correspondence to: F H M Prince f.prince{at}erasmusmc.nl
  • Accepted 4 October 2010

Summary points

  • Early recognition and early aggressive treatment of juvenile idiopathic arthritis prevent joint damage and allow for normal development and growth

  • The disease is heterogeneous and complex, so patients benefit from regular review and management by experts in a multidisciplinary team

  • The disease currently has no cure, but clinical remission is a realistic treatment goal

  • Biological disease modifying antirheumatic drugs are a new and effective treatment for severe disease, but they increase the risk of infection; more data on long term adverse events need to be obtained from registries

  • Trials need to determine the optimal treatment strategies with synthetic and biological disease modifying antirheumatic drugs

Juvenile idiopathic arthritis is the most common cause of chronic arthritis in childhood; a review of 34 epidemiological studies showed that 0.07-4.01 per 1000 children worldwide are affected.w1 It is characterised by joint inflammation that often leads to joint destruction with physical disability and chronic pain that affects daily life.1 During the past decade, increased understanding of the disease has improved treatment, particularly through earlier diagnosis and new treatments that help to prevent long term damage to joints. Earlier this year, the British Society for Paediatric and Adolescent Rheumatology published standards of care for children and young people with juvenile idiopathic arthritis, which outlined the importance of involving different disciplines within healthcare.2 We review recent advances in the diagnosis and management of juvenile idiopathic arthritis, focusing on evidence from randomised controlled trials, cohort studies, systematic reviews, and current guidelines.

Sources and selection criteria

As well as using our personal reference collections, we searched Medline, Embase, and Cochrane Central for clinical studies and reviews using the keywords “juvenile idiopathic arthritis”, “juvenile rheumatoid arthritis”, “juvenile chronic arthritis”, “diagnosis”, “treatment”, “therapy”, “non-steroidal anti-inflammatory drugs”, “corticosteroids”, “disease modifying antirheumatic drugs”, “biologicals”, and “biologics.” We also reviewed guidelines from the British Society …

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