Abstract
Biological therapy is irreplaceable in paediatric rheumatology as well. The main group of diseases for which it has been available in our country since 2003 includes various subtypes of juvenile idiopathic arthritis (JIA).
Today, tumour-necrosis factor-alpha blockers (etanercept, adalimumab) and interleukin-6 blocker (tocilizumab) are authorised in this indication; in Europe also canakinumab and abatacept have been approved. Recent years have seen extension of approved indications to some of the socalled autoinflammatory diseases as well, namely the group of cryopyrinopathies where mainly interleukin-1 blockade is effective.
In the form of special regimens ("off-label"), however, biologicals are also used to treat children with a broad range of systemic inflammatory diseases, especially vasculitides, systemic lupus erythematosus and also dermatomyositis. Systematic disease monitoring using internationally standardized measures and collection of data on drug adverse events in pharmacovigilance registries are important components of therapeutic plan.
Although disease remission is relatively more frequently achieved in children with JIA than in adults with rheumatoid arthritis, disease relapses after discontinuaton of treatment remain an important problem. Relatively large proportion of patients especially with polyarticular forms of JIA carry their disease into adulthood.