Over the past two decades, the management of juvenile idiopathic arthritis (JIA) has been revolutionized by the increased tendency toward early aggressive interventions and the availability of the novel biologic medications. In 2017, three novel randomized controlled trials have evaluated the effectiveness and tolerability of golimumab and tocilizumab in polyarticular JIA, and shown that methotrexate may increase and prolong the effect of intra-articular corticosteroid injection in children with oligoarthritis. A more rational approach to the management of JIA is being fostered by the recent publication of therapeutic recommendations, consensus treatment plans, and advice for the optimal care. A few months ago, an international consensus effort has led to the development of the recommendations for the treat-to-target in JIA. The application of this strategy in routine care may improve disease outcome. Because the potential of attaining inactive disease in children with JIA has markedly increased, there is an urgent need for randomized controlled trials, analyses of clinical data sets, and expert advice to guide discontinuation of medications once complete disease quiescence has been achieved.
Keywords: Biologic agents; Intra-articular corticosteroids; Juvenile idiopathic arthritis; Methotrexate; Treat-to-target strategy; Treatment.
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