Treatment

Document Overview

Design and created by Guideline Central in participation with the American College of Rheumatology.

Treatment of Juvenile Idiopathic Arthritis (JIA): Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint (TMJ) Arthritis and Systemic JIA

American College of Rheumatology

Publication Date: Mar 2, 2022

Page Last Updated: May 5, 2026

Quality of Evidence and Strength of Recommendations

Quality of Evidence	Interpretation
High-quality evidence	Studies that provide high confidence in the effect estimate. New data from future studies are thought unlikely to change the effect.
Moderate-quality evidence	Studies that provide confidence that the true effect is likely to be close to the estimate but could be substantially different.
Low-quality evidence	Studies that provide limited confidence about the effect. The true effect may be substantially different from the estimate.
Very low-quality evidence	Studies that provide very little certainty about the effect. The true effect may be quite different from the estimate.

Strength of Recommendation	Interpretation
Strong recommendation	Action should be favored in almost all patients, usually requiring high-quality evidence, high confidence that future research will not alter the conclusion, AND an assessment that the desirable effects of the intervention outweigh the undesirable effects. Should not be taken to imply that the intervention has large clinical benefits.
Conditional recommendation	Action should be followed in only selected cases, often limited by low-quality evidence, OR when the desirable and undesirable consequences of an intervention are more balanced, OR if patients’ preferences for the intervention are thought to vary widely.

Document Overview

Document Title: Treatment of Juvenile Idiopathic Arthritis (JIA): Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint (TMJ) Arthritis and Systemic JIA

Authoring Society: American College of Rheumatology

Document Publication Date: Mar 2, 2022

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.rheumatology.org/Portals/0/Files/ACR-JIA%20Guideline-Oligo-TMJ-sJIA-EarlyView.pdf

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

Document Scope, Criteria, and Use Cases

Document Objectives: 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.

Scope: Management, Treatment

Diseases/Conditions (MeSH)

D001171 - Arthritis, Juvenile

Keywords: JIA, TMJ, juvenile idiopathic arthritis

Target Patient Population: patients with juvenile idiopathic arthritis (JIA)

Inclusion Criteria: Male, Female, Adolescent, Child

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

In children with oligoarticular JIA, should a trial of scheduled NSAIDs be recommended?
In children with oligoarticular JIA, should adding IAGCs to initial therapy be recommended?
In children with oligoarticular JIA, should a specific steroid type be recommended for intraarticular injection?
In children with oligoarticular JIA, should adding oral steroids to initial therapy be recommended?
In children with oligoarticular JIA, should DMARD therapies be recommended, and should there be any preferred order of treatment: MTX (subcutaneous or oral), LEF, SSZ, and/or HCQ?
In children with oligoarticular JIA, should biologic therapies be recommended, and should there be any preferred order of treatment: TNFi treatment, biologic treatments with other mechanisms of action?
In children with oligoarticular JIA, should poor prognostic features alter the treatment paradigm?
In children with JIA with active TMJ arthritis, should poor prognostic features alter the treatment paradigm?
In children with oligoarticular JIA, should disease activity measures alter the treatment paradigm?

Supplemental Methodology Resources: Evidence Tables Project Plan

Number of Source Documents: 100

Literature Search Start Date: Tuesday, August 6, 2019

Literature Search End Date: Wednesday, July 8, 2020

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Treatment of Juvenile Idiopathic Arthritis (JIA): Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint (TMJ) Arthritis and Systemic JIA

Treatment

Oligoarthritis

TMJ Arthritis

Systemic JIA Inactive Disease

Systemic JIA Without MAS

Systemic JIA With MAS

Quality of Evidence and Strength of Recommendations

Document Overview

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology