Journal article
2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis
Arthritis & rheumatology (Hoboken, N.J.), Vol.71(6), pp.846-863
06/2019
DOI: 10.1002/art.40884
PMCID: PMC6561114
PMID: 31021537
Abstract
To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis.
The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions.
Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies.
This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
Details
- Title: Subtitle
- 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis
- Creators
- Sarah Ringold - Seattle Children's Hospital, Seattle, WashingtonSheila T Angeles-Han - Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OhioTimothy Beukelman - University of Alabama, BirminghamDaniel Lovell - Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OhioCarlos A Cuello - McMaster University, Hamilton, Ontario, CanadaMara L Becker - Children's Mercy Hospital, Kansas City, MissouriRobert A Colbert - National Institutes of Health, Bethesda, MarylandBrian M Feldman - The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, CanadaPolly J Ferguson - University of Iowa Carver College of Medicine, Iowa CityHarry Gewanter - Children's Hospital of Richmond, Virginia Commonwealth University, RichmondJaime Guzman - BC Children's Hospital, Vancouver, British Columbia, CanadaJennifer Horonjeff - Columbia University Medical Center, New York, New YorkPeter A Nigrovic - Brigham & Women's Hospital and Boston Children's Hospital, Boston, MassachusettsMichael J Ombrello - National Institutes of Health, Bethesda, MarylandMurray H Passo - Medical University of South Carolina, CharlestonMatthew L Stoll - University of Alabama, BirminghamC Egla Rabinovich - Duke University, Durham, North CarolinaRayfel Schneider - The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, CanadaOlha Halyabar - Boston Children's Hospital, Boston, MassachusettsKimberly Hays - Medical University of South Carolina, CharlestonAmit Aakash Shah - American College of Rheumatology, Atlanta, GeorgiaNancy Sullivan - ECRI Institute, Plymouth Meeting, PennsylvaniaAnn Marie Szymanski - National Institutes of Health, Bethesda, MarylandMarat Turgunbaev - American College of Rheumatology, Atlanta, GeorgiaAmy Turner - American College of Rheumatology, Atlanta, GeorgiaJames Reston - ECRI Institute, Plymouth Meeting, Pennsylvania
- Resource Type
- Journal article
- Publication Details
- Arthritis & rheumatology (Hoboken, N.J.), Vol.71(6), pp.846-863
- DOI
- 10.1002/art.40884
- PMID
- 31021537
- PMCID
- PMC6561114
- NLM abbreviation
- Arthritis Rheumatol
- ISSN
- 2326-5191
- eISSN
- 2326-5205
- Publisher
- United States
- Grant note
- AR-059-703 / NIH HHS Rheumatology Research Foundation ZIA AR041184-01 / Intramural NIH HHS K23 EY021760 / NEI NIH HHS NIAMS NIH HHS ZIA AR041198-01 / Intramural NIH HHS
- Language
- English
- Date published
- 06/2019
- Academic Unit
- Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Rheumatology, Allergy, and Immunology
- Record Identifier
- 9984070689102771
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