Role of adalimumab in the management of children and adolescents with juvenile idiopathic arthritis and other rheumatic conditions.

Treatment of children and adolescents with juvenile idiopathic arthritis and other pediatric rheumatic diseases has evolved. Where once there was only a limited arsenal of medications, with significant side effects and inadequate efficacy, today, with an increased understanding of the pathogenesis of these diseases, there is a wider variety of more targeted and effective treatments. TNF-α is a cytokine involved in a number of inflammatory pathways in pediatric rheumatic diseases. The emergence of biologic modifiers that target TNF-α has been pivotal in providing the ability to deliver early and aggressive treatment. Adalimumab, a recombinant monoclonal antibody to TNF-α, is an important therapeutic option, which affords children and adolescents with chronic illnesses an improved quality of life.

Early juvenile idiopathic arthritis.

Early juvenile idiopathic arthritis (JIA) is important to recognize as timely diagnosis and treatment improves prognosis. It is a misconception that complications of JIA arise only from long-standing disease and that children will outgrow it. Early aggressive treatment is the paradigm as early disease activity has long-term consequences. There are predictors of persistent disease and joint erosions that may identify patients at higher risk. Control of disease activity within the first 6 months of onset confers improved clinical course and outcomes. The treatment perspective is thus one of early aggressive treatment for induction of disease control and ultimately remission.

Adalimumab in juvenile rheumatoid arthritis/juvenile idiopathic arthritis.

Chronic arthritis in childhood is the most common pediatric rheumatic disease and can lead to significant short- and long-term disability. TNF-a is a cytokine involved in joint inflammation and destruction. It has been suggested that early and aggressive treatment leads to improved outcomes by ameliorating clinical signs and symptoms, inhibiting joint destruction and improving functional disability. The early and aggressive use of disease-modifying antirheumatic drugs and biologic response modifiers are key to achieving this goal. Anti-TNF agents are effective biologic modifiers that have had a major impact on the clinical course of arthritis. Adalimumab, a recombinant monoclonal antibody to TNF-alpha, is emerging as a valuable new therapy for juvenile arthritis.