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  • Review Article
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Treatment of non-systemic juvenile idiopathic arthritis

Nature Reviews Rheumatology volume 20, pages 170–181 (2024)Cite this article

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Abstract

In the past two decades, the treatment of juvenile idiopathic arthritis (JIA) has evolved markedly, owing to the availability of a growing number of novel, potent and relatively safe therapeutic agents and the shift of management strategies towards early achievement of disease remission. However, JIA encompasses a heterogeneous group of diseases that require distinct treatment approaches. Furthermore, some old drugs, such as methotrexate, sulfasalazine and intraarticular glucocorticoids, still maintain an important therapeutic role. In the past 5 years, information on the efficacy and safety of drug therapies for JIA has been further enriched through the accomplishment of several randomized controlled trials of newer biologic and synthetic targeted DMARDs. In addition, a more rational therapeutic approach has been fostered by the promulgation of therapeutic recommendations and guidelines. A multinational collaborative effort has led to the development of the recommendations for the treat-to-target strategy in JIA. There is currently increasing interest in establishing the optimal time and modality for discontinuation of treatment in children with JIA who achieve sustained clinical remission. The aim of this Review is to summarize the current evidence and discuss the therapeutic approaches to the management of non-systemic phenotypes of JIA, including oligoarthritis, polyarthritis, enthesitis-related arthritis and psoriatic arthritis.

Key points

  • In the past two decades, important progress has been made in the management of juvenile idiopathic arthritis, including the availability of new therapeutic agents and the shift towards early aggressive interventions.

  • Several randomized controlled trials, therapeutic recommendations and consensus treatment plans have facilitated a more rational approach to therapy.

  • Contemporary therapeutic goals include early achievement of disease control, sparing use of glucocorticoids and the prevention of disease-related and treatment-related morbidity.

  • The application of the treat-to-target strategy, an innovative treatment modality that has already been explored successfully in pivotal therapeutic studies, is now garnering increased interest.

  • The variability in clinical presentation and course of juvenile idiopathic arthritis implies that the therapeutic choices, optimal targets and treatment strategy might be different across disease categories.

  • The research agenda calls for innovative trials that improve remission rates and pave the way for refined precision studies, personalized medicine and, ultimately, future prevention.

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Authors and Affiliations

  1. Seattle Children’s Hospital and Research Centre, University of Washington, Seattle, WA, USA

    Susan Shenoi

  2. Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany

    Gerd Horneff

  3. Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany

    Gerd Horneff

  4. Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

    Amita Aggarwal

  5. Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy

    Angelo Ravelli

  6. Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy

    Angelo Ravelli

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The authors contributed equally to all aspects of the article

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Correspondence to Angelo Ravelli.

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S.S. declares that she has received consulting fees from Amgen, Novartis and Pfizer, all unrelated to this manuscript. G.H. declares that has he has received grants from MSD, Novartis, Pfizer, Roche and consulting and/or speaker’s fees from AbbVie, Boehringer, Celgene, Chugai, GSK, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi and Sobi, all unrelated to this manuscript. A.R. declares that has he has received grants from Novartis and Pfizer and consulting and/or speaker’s fees from AbbVie, Alexion, Angelini, Galapagos, Novartis, Pfizer, Reckitt-Benkiser, Roche, BMS and SOBI, all unrelated to this manuscript. A.A. declares no competing interests.

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Shenoi, S., Horneff, G., Aggarwal, A. et al. Treatment of non-systemic juvenile idiopathic arthritis. Nat Rev Rheumatol 20, 170–181 (2024). https://doi.org/10.1038/s41584-024-01079-8

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