Two Randomized Trials of Canakinumab in Systemic Juvenile Idiopathic Arthritis

Systemic juvenile idiopathic arthritis (JIA), the most severe JIA subtype, is characterized by chronic arthritis; intermittently high, spiking temperatures; maculopapular rash; hepatosplenomegaly; lymphadenopathy; serositis; and a marked increase in the level of acute-phase reactants.1?3 Complications of systemic JIA include growth impairment, osteoporosis, and the potentially lethal macrophage activation syndrome.4?6 Until recently, systemic JIA was considered a therapeutic orphan, since the principal effective treatment was glucocorticoids, with their known toxicity and long-term growth and bone sequelae.7 Other therapeutic options include nonsteroidal antiinflammatory drugs (NSAIDs), methotrexate, and biologic agents. Both interleukin-68?10 and, more recently, interleukin-111?14 have been found . . .