A review of treatments for polyarticular juvenile idiopathic arthritis

The authors reviewed current treatment options for the treatment of polyarticular juvenile idiopathic arthritis (pJIA).

JIA is the most common form of arthritis in children under the age of 16. In pJIA, more than 6 joints are involved in the first 6 months of the disease. Recent studies have shown that pJIA patients are more likely to have worse outcomes. They are also less likely to have chances of remission (reduction of signs and symptoms).

A review of the current and future treatment options for pJIA will help decide appropriate therapy for pJIA patients. 

The authors aimed to review the guidelines, existing treatments and new drugs for the treatment of pJIA.

Guidelines

According to the guidelines of National Health Service (NHS) England, steroid (hormone) injection through a vein (intravenous) or directly in the affected joint is recommended initially along with methotrexate (Trexall). If the symptoms do not reduce in three months, a biological agent is recommended.

Treatment and future directions

The use of tocilizumab (Actemra, a biological drug) has been effective in pJIA. In a study, 89% of patients treated with toclizumab achieved an ACR30 response (American College of Rheumatology 30 (ACR30) measures the number of symptomatic joints that improve by 30% following treatment). The optimal dose of tocilizumab was 8 mg/kg if the body weight was 30 kg. It was 10 mg/kg if the body weight was less than 10 kg.

The use of tofacitinib (Xeljanz) and biological drugs such as rituximab (Rituxan), certolizumab (Cimzia), golimumab (Simponi) and ustekinumab (Stelara) demonstrated effectiveness in adult RA. These drugs hold promise as new treatments for the treatment of pJIA.

Biomarkers

Biomarkers are naturally occurring body substances associated with a disease. These can help predict progression and survival of a disease. MRP8/14 (S100A8/9), a protein in the blood, is a good predictor of relapse of pJIA after methotrexate is stopped. Other biomarkers are necessary to determine a patient’s risk, course of the disease and possible therapy.

The authors concluded that tocilizumab and rituximab are specific treatments for pJIA. They also suggested that early and aggressive treatments for pJIA are beneficial.