Toward a treat-to-target approach in the management of juvenile idiopathic arthritis

Recent advances in the management of juvenile idiopathic arthritis (JIA) render disease remission an attainable goal in many, if not most, patients. This has led to suggestions that future treatment guidelines include an overriding goal to achieve clinical remission or, at least, minimal disease activity. Furthermore, implementation of treatment strategies aimed at achieving and maintaining tight disease control in standard paediatric rheumatology practice has been proposed. A compelling argument is available at this time to suggest that the incorporation of treat-to-target approach in the management of children with JIA may improve disease outcome. Recently, descriptions of disease states that represent suitable therapeutic targets, such as inactive disease, minimal disease activity, or parent- or child-acceptable symptom states, have been developed. In addition, criteria for these states based on the Juvenile Arthritis Disease Activity Score (JADAS) have been identified. Future studies will clarify whether the addition of an imaging assessment to the management of children with JIA will improve the prediction of clinical outcomes.