Biologic and targeted synthetic therapies in juvenile idiopathic arthritis: a review of current and emerging therapeutic agents.

INTRODUCTION Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children, with varying clinical and immunological features. Over the last twenty years, treatment options for JIA have significantly expanded, with the development of biologic and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs), which have substantially improved clinical outcomes. AREAS COVERED This review provides a comprehensive assessment of bDMARDs and tsDMARDs in the management of JIA, focusing on their therapeutic efficacy, long-term safety profiles, and evolving role in personalized treatment strategies. It integrates comparative data on safety and effectiveness from randomized controlled trials, observational cohorts, and large registry studies. EXPERT OPINION Despite substantial therapeutic progress, achieving sustained, drug-free remission remains a challenge for many JIA patients. Precision medicine - guided by predictive biomarkers, pharmacovigilance data, and real-world evidence - is essential for optimizing individualized care. Future efforts should prioritize the development of safer, more tolerable, and accessible therapies tailored to the unique needs of pediatric populations.