Pediatric rheumatology and the knowledge on pathogenic mechanisms underlying many rheumatologic diseases are developing very rapidly. The discovery of new ways associated with inflammation also suggests the opportunity to use drugs that can selectively inhibit them. Nowadays, beside the re-positioning of drugs that have already been used without success there are new biological cytokine inhibitors and, especially, drugs able to inhibit “small molecules”, such as kinases involved in the cytokine signal transduction. For example, the inflammatory action of interleukins 6 and interferons is mostly mediated by JAK kinase activation that may be blocked by such new inhibitors.
The prescription of the most appropriate drug in a particular clinical case lies in the ability of recognizing a possible molecular deficit in patients’ clinical manifestations that can benefit from a specific treatment. However, at the present state of the art such treatment is still experimental. Moreover, there is not standardized approach to such problems that, instead, is based on the choices made by each physician in each medical center. This occurs within the same country and, unfortunately, even more abroad. However, it is necessary to identify a common diagnostic and therapeutic pathway within the same field, so as to share experience and knowledge.
For this reason, it is essential to sensitize medical doctors who manage these patients (mainly pediatricians and rheumatologists) to the most frequent clinical manifestations of rheumatologic diseases in pediatric age and to the most recent knowledge on the mechanisms that underlie the damage. This way, it will be possible to earlier identify those patients who can benefit from an aimed treatment.