[Drug therapy of inflammatory arthritis in children].

The treatment of juvenile chronic arthritis relies on drugs, but not exclusively. Drug efficacy and tolerance vary according to the disease subtype and the patient's age. Aspirin is the commonest nonsteroid antiinflammatory drug (NSAID) available in pediatrics because of the wide variety of presentations allowing an accurate dosage in low-weight children. Most other NSAIDs are not allowed in France in young age despite their good tolerance. Slow acting antirheumatic drugs are mostly used in the polyarticular subtype. Severe side effects have been described in the systemic subtype, particularly with gold and sulphasalazine. Oligoarticular subtype, the long term prognosis of which is fair, is a good indication to local therapy. Eye localisation should be treated by eyedrops, sometimes by oral steroids. Joint pain, frequent in the undifferentiated spondylarthropathies, responds well to NSAIDs. Oral corticosteroids should be used when NSAIDs are totally ineffective or when they induce side effects. Methotrexate represents a good therapeutic choice in juvenile chronic arthritis but its efficacy may vary according to the subtype. The efficacy of other immunosuppressive drugs deserves to be more accurately assessed in prospective multicentre controlled studies.