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...
Classes of InterventionsHaving trouble vie...
...goarthritis...
...onsistent NSAIDs is conditionally rec...
...r glucocorticoids (IAGCs) are strongly...
...riamcinolone hexacetonide (THA) is stron...
...corticoids are conditionally recommended...
...( Low , Strong )608...
...F, SSZ, HCQ) ( Very low , Strong...
...X) ( Low , Conditional )60...
...HCQ) ( Very low , Conditional )608...
...s are strongly recommended if there is in...
...ferred biologic DMARD. ( Very low ,...
Consideration of risk factors for poor...
...lidated disease activity measures is condition...
...Arthritis
...trial of consistent NSAIDs is condition...
...onditionally recommended as part of initial the...
There is no preferred agent. ( Ve...
...al glucocorticoids are conditionally recommended a...
...entional synthetic DMARDs are strongly recomm...
...te is conditionally recommended as a pref...
...ic DMARDs are conditionally recommended fo...
...no preferred biologic agent. ( Very low , )608...
...eration of poor prognostic features (...
...emic JIA Inactive Disease...
...nd discontinuing glucocorticoids is strongly...
...ing and discontinuing biologic DMARDs...
...mic JIA Without MAS...
...nditionally recommended as initial...
...rticoids are conditionally recommended a...
...synthetic DMARDs are strongly recommend...
...s (interleukin [IL-1 and IL-6 inhibitors...
...ere is no preferred agent. ( Very low , )608...
...and IL-6 inhibitors are strongly recomme...
...DMARDS or conventional synthetic DMA...
...eferred agent. ( Very low , )608...
...stemic JIA With...
...6 inhibitors are conditionally recommended ove...
...ucocorticoids are conditionally recommended a...
...preferred agent. ( Very low , )608...
...RDs or conventional synthetic DMARDs are stro...
...eferred agent. ( Very low , )608...
...1. Treatment for Oligoarth...
...ure 2. Treatment for TMJ Arthritis
...3. Treatment for Systemic J...