Arch Dis Child 99:679-685 doi:10.1136/archdischild-2013-304396
  • Review

New age of biological therapies in paediatric rheumatology

  1. A V Ramanan
  1. Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
  1. Correspondence to Dr A V Ramanan, Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK; avramanan{at}
  • Received 5 December 2013
  • Revised 11 February 2014
  • Accepted 12 February 2014
  • Published Online First 12 March 2014


Many paediatric rheumatic diseases result from the abnormal activation or control of the immune system. Biologic drugs, which are synthesised within a biological system, have been designed to target specific molecules involved in cytokine signalling or cell–cell interactions. The past 15 years have seen a revolution in the range of effective treatments for rheumatic diseases, particularly juvenile idiopathic arthritis (JIA). As a result, the target of inactive disease and minimal long-term disease-associated damage is increasingly becoming achievable. In this article we review evidence from recent trials of the use of biologic drugs in the treatment of systemic JIA, juvenile dermatomyositis and juvenile systemic lupus erythematosus. We also highlight novel agents currently undergoing investigation which may broaden our therapeutic armamentarium over the coming decade. Key to these developments are well-designed multicentre controlled clinical trials and long-term safety monitoring as part of international drug registries.

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