Review of Biologics in Children With Rheumatic Diseases

Shabina Habibi; Athimalaipet V Ramanan

Disclosures

Int J Clin Rheumatol. 2012;7(1):81-93. 

In This Article

JIA

JIA is the most common idiopathic inflammatory arthritis of childhood, with prevalence rates ranging from 0.07 to 10 per 1000 children.[2,3] It is defined as arthritis that begins prior to 16 years of age, is of unknown etiology and persists for longer than 6 weeks. According to the International League Against Rheumatology (ILAR) classification, JIA is subdivided into seven distinct categories (Table 1).[4] For decades, the primary aim of management of JIA was control of pain and inflammation. However, with the increasing range of drugs available today, especially biologics, induction of complete remission is a logical goal. However, not all the biologics available are either US FDA or EMA approved, and most are currently used as off-label medications.

The general treatment goals of JIA include elimination of active disease and normalization of joint function, so as to preserve normal growth and development, and to prevent long-term joint damage and deformities. To assess improvement in clinical trials, an important requirement is a set of validated outcome measures. To this end, the 'core-set' criteria have been developed and validated for JIA. These six pediatric American College of Rheumatology (ACR-Pedi) criteria are shown in Box 1. An ACR-Pedi 30 response is defined as 30% improvement in three out of six criteria without worsening of >30% in more than one of the remaining criteria. ACR-Pedi 50 and 70 responses include 50 or 70% improvement, respectively, in at least three out of six criteria with worsening of 30% in no more than one criterion.

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