Remission in pediatric rheumatology

After definition of disease activity, improvement and deterioration and establishing large international research alliances, the new biologicals could be tested in patients with juvenile idiopathic arthritis (JIA) in controlled studies and the effectiveness could be shown. More frequently than ever before even children with polyarticular JIA achieved a state without residual disease activity indicating the need for a definition of remission. The Wallace criteria have attained a large circulation and define inactive disease and remission under and without antirheumatic medication. However, they are not associated with the prognosis. So far biomarkers or imaging cannot improve these clinical criteria. Although many patients achieve inactive disease few of them remain free of disease when all drugs have been stopped. Moreover, gene expression of children in remission still remains pathological. This confirms that children with JIA can be treated better and better but still cannot be cured.