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Corticosteroids in Juvenile Idiopathic Arthritis

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Systemic Corticosteroids for Inflammatory Disorders in Pediatrics

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Abstract

Juvenile idiopathic arthritis (JIA) is the most common chronic condition in pediatric rheumatology. Corticosteroids have been used for the treatment of JIA since the 1950s. Although biologic agents have revolutionized the management of JIA in the past 15 years, corticosteroids still have a significant place in the pharmacological treatment of the disease. Each JIA category (systemic, rheumatoid factor–negative and –positive polyarthritis, oligoarthritis, psoriatic arthritis, enthesitis-related arthritis, and undifferentiated arthritis) exhibits a distinctive response to corticosteroid treatment. Methylprednisolone and prednisone are the most commonly used systemically active agents in JIA. The most frequent indications are anemia, serositis, pneumonitis, and the macrophage activation syndrome, which are usually encountered in patients with systemic arthritis. Pulsed, intravenous higher-dose corticosteroid (methylprednisolone) is often required to control these severe manifestations of JIA. Systemic corticosteroids are also used as a bridging therapy until disease-modifying drugs become effective in certain patients. The evidence supporting the efficacy and safety of systemic steroids in JIA is scarce and limited to uncontrolled, open trials. Corticosteroids are also frequently used as intra-articular therapy in oligoarthritis (and psoriatic, polyarticular, enthesitis-related, and undifferentiated arthritis). The drug of choice for intra-articular therapy is triamcinolone hexacetonide, which has shown high effectiveness in oligoarthritis. JIA-related refractory uveitis is another indication for the use of topical and systemic corticosteroids. The advent of new, biological therapies has restricted the use of systemic corticosteroids to particular situations and allowed for the earlier tapering of dosing in JIA.

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  1. Service of Immunology and Rheumatology, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Pichincha 1880, Buenos Aires, 1245, Argentina

    María M. Katsicas MD & Ricardo A. G. Russo MD

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  1. María M. Katsicas MD
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  2. Ricardo A. G. Russo MD
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Correspondence to María M. Katsicas MD .

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  1. AOU Meyer Pediatric Rheumatology, Firenze, Italy

    Rolando Cimaz

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Katsicas, M.M., Russo, R.A.G. (2015). Corticosteroids in Juvenile Idiopathic Arthritis. In: Cimaz, R. (eds) Systemic Corticosteroids for Inflammatory Disorders in Pediatrics. Adis, Cham. https://doi.org/10.1007/978-3-319-16056-6_6

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