Treatment of Juvenile Idiopathic Arthritis (JIA): Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint (TMJ) Arthritis and Systemic JIA
Publication Date: March 3, 2022
Last Updated: September 2, 2022
Treatment
Oligoarthritis
A trial of consistent NSAIDs is conditionally recommended as part of initial therapy. ( Very low , Conditional )
608
Intra-articular glucocorticoids (IAGCs) are strongly recommended as part of initial therapy. ( Very low , Strong )
608
Triamcinolone hexacetonide (THA) is strongly recommended as the preferred agent. ( Low , Strong )
608
Oral glucocorticoids are conditionally recommended against as part of initial therapy. ( Very low , Conditional )
608
Conventional synthetic DMARDs are strongly recommended if there is an inadequate response to scheduled NSAIDs and/or IAGCs.
(MTX) ( Low , Strong )
608
(LEF, SSZ, HCQ) ( Very low , Strong )
608
Methotrexate (MTX) is (LEF, SSZ, HCQ) conditionally recommended as a preferred agent over leflunomide (LEF), sulfasalazine (SSZ) and hydroxychloroquine (HCQ) (in that order).
(MTX) ( Low , Conditional )
608
(LEF, SSZ, HCQ) ( Very low , Conditional )
608
Biologic DMARDs are strongly recommended if there is inadequate response to or intolerance of NSAIDs and/or IAGCs and at least one conventional synthetic DMARD. ( Very low , Strong )
608
There is no preferred biologic DMARD. ( Very low , )
608
Consideration of risk factors for poor outcome (e.g., involvement of ankle, wrist, hip and/or temporomandibular joint arthritis (TMJ), presence of erosive disease, delay in diagnosis, elevated inflammatory markers, symmetric disease) is conditionally recommended to guide treatment decisions. ( Very low , Conditional )
608
Use of validated disease activity measures is conditionally recommended to guide treatment decisions, especially to facilitate treat-to-target approaches. ( Very low , Conditional )
608
TMJ Arthritis
A trial of consistent NSAIDs is conditionally recommended as part of initial therapy. ( Very low , Conditional )
608
IAGCs are conditionally recommended as part of initial therapy. ( Very low , Conditional )
608
There is no preferred agent. ( Very low , )
608
Oral glucocorticoids are conditionally recommended against as part of initial therapy. ( Very low , Conditional )
608
Conventional synthetic DMARDs are strongly recommended for inadequate response or intolerance to NSAIDs and/or IAGCs. ( Very low , Strong )
608
Methotrexate is conditionally recommended as a preferred agent over leflunomide. ( Very low , Conditional )
608
Biologic DMARDs are conditionally recommended for inadequate response or intolerance to NSAIDs and/or IAGCs and at least one conventional synthetic DMARD. ( Very low , Conditional )
608
There is no preferred biologic agent. ( Very low , )
608
Consideration of poor prognostic features (e.g., involvement of ankle, wrist, hip and/or TMJ, presence of erosive disease, delay in diagnosis, elevated inflammatory markers, symmetric disease) is conditionally recommended to guide treatment decisions. ( Very low , Conditional )
608
Systemic JIA Inactive Disease
Tapering and discontinuing glucocorticoids is strongly recommended after inactive disease has been attained. ( Very low , Strong )
608
Tapering and discontinuing biologic DMARDs is conditionally recommended after inactive disease has been attained. ( Very low , Conditional )
608
Systemic JIA Without MAS
NSAIDs are conditionally recommended as initial monotherapy. ( Very low , Conditional )
608
Oral glucocorticoids are conditionally recommended against as initial monotherapy. ( Very low , Conditional )
608
Conventional synthetic DMARDs are strongly recommended against as initial monotherapy. ( Very low , Strong )
608
Biologic DMARDs (interleukin [IL-1 and IL-6 inhibitors]) are conditionally recommended as initial monotherapy. ( Very low , Conditional )
608
There is no preferred agent. ( Very low , )
608
IL-1 and IL-6 inhibitors are strongly recommended over a single or combination of conventional synthetic DMARDs for inadequate response to or intolerance of NSAIDs and/or glucocorticoids. ( Very low , Strong )
608
Biologic DMARDS or conventional synthetic DMARDS are strongly recommended over long-term glucocorticoids for residual arthritis and incomplete response to IL-1 and/or IL-6 inhibitors. ( Very low , Strong )
608
There is no preferred agent. ( Very low , )
608
Systemic JIA With MAS
IL-1 and IL-6 inhibitors are conditionally recommended over calcineurin inhibitors alone to achieve inactive disease and resolution of MAS. ( Very low , Conditional )
608
Glucocorticoids are conditionally recommended as part of initial treatment of systemic JIA with MAS. ( Very low , Conditional )
608
There is no preferred agent. ( Very low , )
608
Biologic DMARDs or conventional synthetic DMARDs are strongly recommended over long-term glucocorticoids for residual arthritis and an incomplete response to IL-1 and/or IL-6 inhibitors. ( Very low , Strong )
608
There is no preferred agent. ( Very low , )
608
Recommendation Grading
Overview
Title
Treatment of Juvenile Idiopathic Arthritis (JIA): Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint (TMJ) Arthritis and Systemic JIA
Authoring Organization
American College of Rheumatology
Publication Month/Year
March 3, 2022
Last Updated Month/Year
February 23, 2024
Document Type
Guideline
Country of Publication
US
Inclusion Criteria
Male, Female, Adolescent, Child
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Treatment, Management
Diseases/Conditions (MeSH)
D001171 - Arthritis, Juvenile
Keywords
juvenile idiopathic arthritis, JIA, TMJ
Source Citation
Onel KB, Horton DB, Lovell DJ, et al. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis (JIA): Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint (TMJ) Arthritis and Systemic JIA
Supplemental Methodology Resources
Methodology
Number of Source Documents
100
Literature Search Start Date
August 7, 2019
Literature Search End Date
July 9, 2020