Juvenile Idiopathic Arthritis
Key Points
Key Points
- Juvenile arthritis is one of the most common chronic diseases of childhood, with an estimated prevalence of 1 per 1,000 children.
- Following the exclusion of other known causes of synovitis, the term juvenile idiopathic arthritis (JIA) defines a heterogeneous collection of inflammatory arthritides of unknown etiology with onset prior to age 16 years and a minimum duration of 6 weeks.
- All forms of JIA are associated with decreased health-related quality of life and risk of permanent joint damage. The disease may persist into adulthood, causing ongoing significant morbidity and impaired quality of life.
- A number of treatments are available, including nonsteroidal antiinflammatory drugs (NSAIDs), systemic and intra-articular glucocorticoids, and nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs).
- Prompt initiation of appropriate therapy is of critical importance in preventing permanent damage and improving outcomes.
Treatment
...atment...
...le 1. Terms and definitionsaHaving...
...2. Interventions included in the literat...
...neral medication recommendations for chil...
...tion is preceded by the phrase: ...
NSAI...
...re conditionally recommended as adjunct therapy...
DMAR...
...mide (, Moderate )607
sulfasalazine (, Very Low...
...taneous methotrexate is conditionally recommende...
...cocorticoi...
...lar glucocorticoids are conditionally r...
...lone hexacetonide is strongly recommended ove...
...ing therapy with a limited course of oral glucocor...
...onally recommend against bridging therapy with...
...end against adding chronic low-dose gluc...
...logic DMARD...
...tanercept, golimumab (, Very Low...
...cept, or tocilizumab (, L...
...b (, Moderate )607...
...bination therapy with a DMARD is strongly reco...
...sical therapy and occupational therapy
...cal therapy (, Low )607...
...therapy (, Very Low )607...
...idelines for the initial and subsequent tre...
...ase activity (moderate/high and low)...
...recommendation is preceded by the phras...
...ial therapy...
...ll patient...
...al therapy with a DMARD is strongly recommended...
...thotrexate monotherapy as initial therapy is cond...
...atients without risk f...
...apy with a DMARD is conditionally recommend...
...nts with risk factors:...
...therapy with a DMARD is conditionally recomm...
...ubsequent therapy: Low disease activity (cJADA...
...hildren receiving a DMARD and/or biologic:...
...py is conditionally recommended over...
...herapy: Moderate/high disease activity...
...receiving DMARD monotherapy:...
...ng a biologic to original DMARD is con...
...a biologic is conditionally recommended ov...
...receiving first TNFi (± DMARD):...
...izumab or abatacept) is conditional...
...is receiving second biologic:
...i, abatacept, or tocilizumab (depending on pr...
...re 1. Summary of primary recommenda...
...dations for the initial and subsequent t...
...n children and adolescents with active...
...ren and adolescents with active sac...
...strongly recommended over continue...
...asalazine for patients who have contrain...
...recommend against using methotrexate monothe...
Glucocorti...
...adolescents with active sacroiliit...
...with a limited course of oral glucocorticoid...
...a-articular glucocorticoid injection of...
...ical therapy...
...ldren and adolescents with sacroiliitis who...
...tions for the initial and subsequent t...
...n children and adolescents with active enthes...
...adolescents with active enthesitis despite trea...
...conditionally recommended over methotrex...
...idging therapy with a limited course of oral glu...
...sical therapy...
...ren and adolescents with enthesitis who have or a...