Department of Pediatrics, Ospedale San Giovanni, 6500, Bellinzona, Switzerland.
Unité Romande d'Immuno-rhumatologie Pédiatrique (URIRP), Département Femme-Mère-Enfant (DFME), CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Eur J Pediatr. 2017 Sep;176(9):1147-1153. doi: 10.1007/s00431-017-2960-6. Epub 2017 Jul 20.
In the past years, pediatric rheumatology has seen a revolution in the treatments for rheumatic diseases, particularly juvenile idiopathic arthritis. Even if nonsteroidal anti-inflammatory drugs (NSAID), intra-articular corticosteroids (IAC) injections, and methotrexate remain the mainstay of the treatment for JIA patients, in aggressive disease, these treatments may be not sufficient to reach disease remission and to prevent long-term disability. Comprehension of immunological mechanisms involved in the pathogenesis of the diseases allowed to conceive new drugs targeting specific steps of the immune response. Several cytokines, like TNF alpha and IL-1, represent a very interesting target for biologic therapies. Due to the efficacy of these therapies, nowadays, "disease remission" in pediatric rheumatology is more and more frequent, especially in juvenile idiopathic arthritis patients, and the long-term outcomes have been significantly improved. Crucial to these advancements have been multicenter controlled clinical trials and long-term safety monitoring.
Research in pediatric rheumatology has resulted in dramatic advances in diseases management. Biologic treatments have improved physical and functional outcomes and quality of life of patients with rheumatic disease. What is Known: • NSAID, intra-articular injection of corticoids, and methotrexate are the mainstay in treatment of JIA. • In aggressive JIA, these treatments may be not sufficient to reach disease remission and to prevent long term disability. What is New: • In recent years, management of JIA has significantly improved with the development of biologic therapies that allowed children with arthritis to reach a normal growth and to achieve a good long-term functional outcome.
在过去的几年中，儿科风湿病学在风湿性疾病的治疗方面发生了革命性的变化，尤其是在青少年特发性关节炎方面。即使非甾体抗炎药（NSAID）、关节内皮质类固醇（IAC）注射和甲氨蝶呤仍然是 JIA 患者治疗的主要方法，但在侵袭性疾病中，这些治疗方法可能不足以达到疾病缓解并预防长期残疾。对疾病发病机制中涉及的免疫机制的理解，使得针对免疫反应特定步骤的新药成为可能。几种细胞因子，如 TNF-α 和 IL-1，是生物治疗的非常有吸引力的靶标。由于这些治疗方法的疗效，如今，儿科风湿病学中的“疾病缓解”越来越常见，尤其是在青少年特发性关节炎患者中，长期结果得到了显著改善。多中心对照临床试验和长期安全性监测对这些进展至关重要。
儿科风湿病学的研究在疾病管理方面取得了重大进展。生物治疗改善了风湿性疾病患者的身体和功能结局以及生活质量。已知情况：• NSAID、关节内皮质类固醇注射和甲氨蝶呤是 JIA 的主要治疗方法。• 在侵袭性 JIA 中，这些治疗方法可能不足以达到疾病缓解和预防长期残疾。新情况：• 近年来，随着生物治疗的发展，JIA 的治疗得到了显著改善，这使得关节炎儿童能够正常生长并获得良好的长期功能结局。
