Selective inhibitors of cyclo-oxygenase (COX)-2 have demonstrated efficacy at least comparable to that of NSAIDs in the treatment of rheumatoid arthritis and acute and chronic pain. Data from research studies and experience in clinical practice have shown that COX-2 inhibitors have a favourable safety profile compared with NSAIDs, particularly with respect to adverse gastrointestinal effects. However, the efficacy and safety of selective COX-2 inhibitors in patients with juvenile rheumatoid arthritis (JRA) has remained undetermined. Results from the first clinical study to evaluate a COX-2 inhibitor in JRA, presented at the 67th Annual Scientific Meeting of the American College of Rheumatology (ACR) [Orlando, US; October 2003], indicate that rofecoxib [Vioxx] has efficacy comparable to that of the NSAID naproxen. The overall safety and tolerability profiles of the two agents were comparable, although a trend towards fewer gastrointestinal adverse events was observed in patients treated with rofecoxib.