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Patients with juvenile idiopathic arthritis (JIA) present with varying degrees of long-term joint sequelae; those with polyarticular involvement generally have longer periods of disease activity and greater long-term joint damage than do patients with oligoarthritis. When early treatment with nonsteroidal anti-inflammatory agents (NSAIDs) is not effective, corticosteroids or disease modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX), sulfasalazine, leflunamide, or hydroxycholoroquine are prescribed. In an open-label randomized trial, investigators in Finland compared three approaches to early treatment of polyarticular JIA in 60 patients (age range, 4–15 years) with steroid- and DMARD-naive disease.
Patients were randomized to…