Aspirin continues to hold its place as a cheap and effective way of treating patients with juvenile arthritis. The article by Doughty and his colleagues in this issue (p 461) reiterates aspirin's effectiveness and gives us a number of practical points in its usage.
Although rheumatologists (and Jane Schaller recently for children1) have often pointed out the desirability of maintaining serum salicylate levels between 20 and 30 mg/dL, this report satisfactorily establishes these limits. Most important is the upper limit where the authors have shown that there is no significant improvement in clinical response with salicylate levels higher than 30 mg/dL. When other nonsteroidal anti-inflammatory drugs were not available for the treatment of juvenile arthritis, it was thought to be worthwhile to try to push aspirin levels higher than 30 mg/dL. However, with the availability of at least one of the newer agents, tolmetin sodium,2 it probably is inadvisable