Journal article
2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis
Arthritis care & research (2010), Vol.74(4), pp.521-537
03/01/2022
DOI: 10.1002/acr.24853
PMCID: PMC10124899
PMID: 35233986
Abstract
To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided.
We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.
Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional.
This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
Details
- Title: Subtitle
- 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis
- Creators
- Karen B Onel - Hospital for Special SurgeryDaniel B Horton - Rutgers, The State University of New JerseyDaniel J Lovell - Cincinnati Children's Hospital Medical CenterSusan Shenoi - University of WashingtonCarlos A Cuello - McMaster UniversitySheila T Angeles-Han - Cincinnati Children's Hospital Medical CenterMara L Becker - Duke UniversityRandy Q Cron - University of Alabama at BirminghamBrian M Feldman - University of TorontoPolly J Ferguson - University of IowaHarry Gewanter - Virginia Commonwealth UniversityJaime Guzman - Case Western Reserve UniversityYukiko Kimura - Hackensack University Medical CenterTzielan Lee - Stanford UniversityKatherine Murphy - Louisiana Department of Health, New Orleans.Peter A Nigrovic - Brigham and Women's HospitalMichael J Ombrello - National Institute of Arthritis and Musculoskeletal and Skin DiseasesC Egla Rabinovich - Duke UniversityMelissa Tesher - University of ChicagoMarinka Twilt - Alberta Children's HospitalMarisa Klein-Gitelman - Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois.Fatima Barbar-Smiley - Nationwide Children's HospitalAshley M Cooper - Children's Mercy HospitalBarbara Edelheit - Children's Medical CenterMiriah Gillispie-Taylor - Baylor College of MedicineKimberly Hays - Penn State Milton S. Hershey Medical CenterMelissa L Mannion - University of Alabama at BirminghamRosemary Peterson - Children's Medical CenterElaine Flanagan - Emory UniversityNadine Saad - University of MichiganNancy Sullivan - ECRI InstituteAnn Marie Szymanski - Johns Hopkins All Children's HospitalRebecca Trachtman - Icahn School of Medicine at Mount SinaiMarat Turgunbaev - American College of RheumatologyKeila Veiga - Boston Children's HospitalAmy S Turner - American College of RheumatologyJames T Reston - ECRI Institute
- Resource Type
- Journal article
- Publication Details
- Arthritis care & research (2010), Vol.74(4), pp.521-537
- DOI
- 10.1002/acr.24853
- PMID
- 35233986
- PMCID
- PMC10124899
- NLM abbreviation
- Arthritis Care Res (Hoboken)
- eISSN
- 2151-4658
- Language
- English
- Date published
- 03/01/2022
- Academic Unit
- Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Rheumatology, Allergy, and Immunology
- Record Identifier
- 9984227002702771
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