Systemic Onset of juvenile idiopathic arthritis : from Diagnosis to Treatment

Abstract

The systemic onset of juvenile idiopathic arthritis (SO-JIA) or Still's disease of child is an auto-inflammatory disease in which there is activation of production of interleukin 1ß(IL1ß) whose induce an excessive production of pro-inflammatory cytokines as interleukine18 and IL6, responsible of clinical symptoms. The diagnosis is made on clinical features, defined by criteria of ILAR, and after exclusion of all differential diagnosis: infectious, tumoral or inflammatory diseases. The synthetic DMARD's are less used than biotherapy: According to the recommendations of ACR 2013, the inhibitors of interleukins 1 (Kineret®, Canakinumab®) and interleukins 6 (Tocilizumab®) are indicated respectively if systemic features or articular features are predominant. These agents are efficacious and induce clinical and biological remission, allowing decrease and even stopping corticosteroids. The prognosis of the disease is transformed by the biotherapy but the morbidity is still high especially in the persistent chronic form.