Thirty years ago, the outlook for any of the rheumatologic disorders in childhood was fairly grim. A rheumatologist's armamentarium consisted of aspirin and a few other non-steroidal anti-inflammatory drugs, gold injections and corticosteroids. Cushing's syndrome, short stature and cataracts were the price to pay for relief from arthritis.

Prognosis improved significantly with the use of methotrexate in the mid-1980s. Small doses of this agent (better known for its role in cancer chemotherapy) allowed many children to stop taking prednisone and lead more normal lives. However, as with any therapeutic agent, not everyone responded,and a small minority suffered untenable side effects.

Thirty years ago also was the dawn of the era of molecular biology. DNA sequencing, gene cloning and the production of monoclonal antibodies had arrived. These laboratory techniques also brought new therapies. The age of molecular biology rapidly led to a better understanding of the immune system and the identification...

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