Randomized Trial of Tocilizumab in Systemic Juvenile Idiopathic Arthritis

Systemic juvenile idiopathic arthritis (JIA) is characterized by chronic arthritis, systemic manifestations (spiking fever, rash, hepatosplenomegaly, lymphadenopathy, and serositis), and substantially elevated inflammatory markers.1 It is the most severe subtype of JIA; approximately half the patients have an unremitting course of chronic polyarthritis (with or without persistent systemic features). Substantial joint damage and disability often develop in these patients.2,3 Treatment remains challenging because of the limited efficacy of methotrexate4 and tumor necrosis factor inhibitors5,6 and because of the major toxicity of high-dose glucocorticoids. Efficacy of the interleukin-1 inhibitor anakinra has been reported in a subset of patients.7? . . .