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
...reatment...
...Terms and definitionsaHaving troubl...
...e 2. Interventions included in the...
...medication recommendations for chi...
...mmendation is preceded by the phrase: “In c...
...SAIDs...
...itionally recommended as adjunct therapy. (,...
...ARDs
leflunomide (, Mode...
...alazine (, Very Low...
...taneous methotrexate is conditional...
...ocorticoids
...ar glucocorticoids are conditionally re...
...nolone hexacetonide is strongly recomme...
...with a limited course of oral glucocorticoid (...
...y recommend against bridging therapy w...
Strongly recommend against adding chronic low-dos...
Biologic DM...
...t, golimumab (, Very Low )607...
...or tocilizumab (, Low )607...
...limumab (, Moderate )6...
...on therapy with a DMARD is strongly re...
...ysical therapy and occupational...
physical therapy (, Low )...
...l therapy (, Very Low )607
...eneral guidelines for the initial and subsequent...
...ase activity (moderate/high and low) as def...
...tion is preceded by the phrase: “In children and...
...ial therapy...
...l patients
...herapy with a DMARD is strongly recommended over...
...thotrexate monotherapy as initial thera...
...tients without risk facto...
...y with a DMARD is conditionally recomm...
Patients with risk f...
...therapy with a DMARD is conditionally re...
...therapy: Low disease activity (cJADAS-10 ≤...
...dren receiving a DMARD and/or biologic:...
...rapy is conditionally recommended ove...
...ubsequent therapy: Moderate/high disease activit...
...tient is receiving DMARD monotherap...
...biologic to original DMARD is conditionally reco...
Adding a biologic is conditionally recommen...
...t is receiving first TNFi (± DMARD):...
...ologic (tocilizumab or abatacept) is conditiona...
...patient is receiving second biologi...
...batacept, or tocilizumab (depending on...
...1. Summary of primary recommendatio...
...mmendations for the initial and subsequent...
...n children and adolescents with active sacro...
...en and adolescents with active sac...
...TNFi is strongly recommended over contin...
...ine for patients who have contrain...
...ngly recommend against using methot...
...corticoids...
...nd adolescents with active sacroiliitis despite...
...ng therapy with a limited course of oral glucoco...
...ntra-articular glucocorticoid injection of the...
...cal therapy...
...dren and adolescents with sacroiliitis who h...
...ecommendations for the initial and subsequent t...
...hildren and adolescents with active e...
...hildren and adolescents with activ...
...TNFi is conditionally recommended over methotr...
...py with a limited course of oral gluco...
...cal therapy...
...hildren and adolescents with enthesitis wh...