With greater understanding of pathophysiological, genetic and environmental influences on juvenile arthritis, there is an opportunity to develop new targets for therapy and greater control of disease. Early, aggressive control of arthritis is essential in order to prevent long-term disability. For those children that are resistant to standard therapy, new and exciting alternative medications are emerging. However, continued research is needed to gain a greater understanding of immunological and genetic profiles of the disease. Pharmaco-vigilance is essential to establish efficacy and side effect profiles. Physiotherapy, occupational therapy, nursing issues, and psychology remain integral to the management of JIA, along with liaison with ophthalmology, orthopaedic and dental colleagues. This article reviews the current biologic treatment options available for children with arthritis and the evidence base that supports their use.