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Theoretical and practical basis for early aggressive therapy in paediatric autoimmune disorders
Current Opinion in Rheumatology, 08/17/09

Woo P - Review emphasizes that the use of potent anti-inflammatory therapies early in the evolution of the pediatric autoimmune disorders in question can limit damage and allow the possibility of normal life and function in the child.

Methods

This review aims to highlight:
- The consequences of chronic inflammation, and
- Change to outcomes if adequate or 'aggressive' treatment is given early to induce remission
  in pediatric autoimmune diseases

Results

Disorders reviewed are:
- Juvenile idiopathic arthritis
- Systemic lupus erythematosis
- Wegener's granulomatosis
- Juvenile dermatomyositis
- Juvenile scleroderma, and
- Autoinflammatory syndromes
If an inflammatory disease is not suppressed sufficiently, then chronic inflammation will cause eventual damage to the organs affected
This can be rapid in the case of multisystem diseases such as SLE
In the case of arthritis, there is a gradual deterioration of function due to loss of cartilage, overgrowth and fusion of bones
Currently, there is no drug-free cure for these diseases, with exception of autologous stem cell transplant in some pts
Thus, some pts may face life-long exposure to potent immunosuppressive/biologic agents with possible long-term sequelae
Anecdotal reports in children suggest that early treatment that leads to disease remission may reduce the burden of exposure to toxic therapies as well as damage to affected systems and organs