Juvenile Idiopathic Arthritis — Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis and Systemic JIA
Key Points
Key Points
- Consistent with the ACR’s 2019 JIA guidelines, these recommendations are for persons already diagnosed with juvenile idiopathic arthritis (JIA).
- Aside from poor prognostic features specified within the recommendations themselves (e.g., specific joints for oligoarthritis, macrophage activation syndrome [MAS]), extra-articular coexisting conditions that would influence disease management, such as uveitis, psoriasis or inflammatory bowel disease, are not addressed within these guidelines.
- Recommendations are intended to be used by all clinicians caring for persons with JIA and assume that patients do not have contraindications to the recommended pharmacologic treatments.
- Longer-term glucocorticoid therapy in childhood is not appropriate because of its effects on bone health and growth. Thus, wherever glucocorticoids are suggested, recommended treatment should be limited to the lowest effective dose for the shortest duration possible.
- Shared decision-making with families and patients is important when considering treatment options.
Treatment
...reatment...
...terventionsHaving trouble viewing table? Expand...
...ligoarthritis
...sistent NSAIDs is conditionally recommended...
...lar glucocorticoids (IAGCs) are strongly recomme...
...riamcinolone hexacetonide (THA) is strong...
...l glucocorticoids are conditionally recommended...
...( Low , Strong )60...
..., HCQ) ( Very low , Strong )608...
...w , Conditional )608...
...EF, SSZ, HCQ) ( Very low , Conditional )608...
...are strongly recommended if there is inadequat...
...erred biologic DMARD. ( Very low , )608...
...on of risk factors for poor outcome...
...dated disease activity measures is condi...
...Arthritis...
...al of consistent NSAIDs is conditionally reco...
...itionally recommended as part of initial the...
...here is no preferred agent. ( Very low , )608
...l glucocorticoids are conditionally recomm...
...synthetic DMARDs are strongly recommended for i...
...otrexate is conditionally recommended as a...
...RDs are conditionally recommended for ina...
...o preferred biologic agent. ( Very low , )608...
...on of poor prognostic features (e.g., invol...
...ystemic JIA Inactive...
...ering and discontinuing glucocorti...
...and discontinuing biologic DMARDs is cond...
...JIA Without MAS...
...itionally recommended as initial monotherapy. ( V...
...ucocorticoids are conditionally recommended a...
...synthetic DMARDs are strongly recom...
Biologic DMARDs (interleukin [IL-1 and IL...
...preferred agent. ( Very low , )608...
...hibitors are strongly recommended over a single o...
...DMARDS or conventional synthetic DMA...
...no preferred agent. ( Very low , )608...
...ic JIA With MAS...
...L-1 and IL-6 inhibitors are conditional...
...cocorticoids are conditionally recommended as pa...
...o preferred agent. ( Very low ,...
...MARDs or conventional synthetic DMARDs are s...
...is no preferred agent. ( Very low , )608...
...gure 1. Treatment for Oligoart...
...re 2. Treatment for TMJ Arthritis
...Treatment for Systemic JIA...