Biologic therapies for juvenile arthritis

  • N. W
  • G. J
  • 1

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Abstract

A group of therapies with exciting potential has emerged for children and young people with severe juvenile idiopathic arthritis (JIA) uncontrolled by conventional disease modifying drugs. Theoretical understanding from molecular biologic research has identified specific targets within pathophysiological pathways that control rheumatoid arthritis (RA) and JIA. This review identifies the pathways of autoimmunity to begin to show how biologic agents have been produced to replicate, mimic, or block culpable molecules and so promote or inhibit cellular activity or proliferation. Of these agents, cytokine antagonists have shown greatest promise, and early clinical studies of tumour necrosis factor (TNF) blockade have identified dramatic clinical benefit in many children with JIA. However, as will also be discussed, overlap of pathways within a complex immune system makes clinical response unpredictable and raises additional ethical and administrative concerns.

Author-supplied keywords

  • *immunologic agent/dt [Drug Therapy]
  • *immunologic agent/pd [Pharmacology]
  • *immunotherapy
  • *juvenile rheumatoid arthritis/dt [Drug Therapy]
  • abdominal pain/si [Side Effect]
  • aplastic anemia/si [Side Effect]
  • autoimmunity
  • corticosteroid/dt [Drug Therapy]
  • corticosteroid/pd [Pharmacology]
  • cyclosporin A/dt [Drug Therapy]
  • cyclosporin A/pd [Pharmacology]
  • demyelinating disease/si [Side Effect]
  • drug activity
  • drug effect
  • drug receptor binding
  • etanercept/ae [Adverse Drug Reaction]
  • etanercept/dt [Drug Therapy]
  • headache/si [Side Effect]
  • human
  • immune system
  • immunomodulation
  • infection/si [Side Effect]
  • infliximab/cb [Drug Combination]
  • infliximab/dt [Drug Therapy]
  • infliximab/iv [Intravenous Drug Administration]
  • infliximab/pd [Pharmacology]
  • leflunomide/dt [Drug Therapy]
  • leflunomide/pd [Pharmacology]
  • leukopenia/si [Side Effect]
  • medical ethics
  • methotrexate/cb [Drug Combination]
  • methotrexate/dt [Drug Therapy]
  • nausea/si [Side Effect]
  • pancytopenia/si [Side Effect]
  • priority journal
  • recombinant interleukin 1/do [Drug Dose]
  • recombinant interleukin 1/dt [Drug Therapy]
  • recombinant interleukin 1/pd [Pharmacology]
  • recombinant interleukin 10/dt [Drug Therapy]
  • recombinant interleukin 10/pd [Pharmacology]
  • review
  • salazosulfapyridine/dt [Drug Therapy]
  • side effect/si [Side Effect]
  • thalidomide/dt [Drug Therapy]
  • thalidomide/pd [Pharmacology]
  • tumor necrosis factor alpha/ae [Adverse Drug React
  • tumor necrosis factor alpha/dt [Drug Therapy]
  • tumor necrosis factor alpha/pd [Pharmacology]
  • tumor necrosis factor alpha/sc [Subcutaneous Drug
  • tumor necrosis factor/ae [Adverse Drug Reaction]
  • tumor necrosis factor/dt [Drug Therapy]
  • tumor necrosis factor/pd [Pharmacology]
  • vomiting/si [Side Effect]

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Authors

  • Wilkinson N.

  • Jackson G.

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