Juvenile Idiopathic Arthritis — Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis and Systemic JIA
Key Points
Key Points
- Consistent with the ACR’s 2019 JIA guidelines, these recommendations are for persons already diagnosed with juvenile idiopathic arthritis (JIA).
- Aside from poor prognostic features specified within the recommendations themselves (e.g., specific joints for oligoarthritis, macrophage activation syndrome [MAS]), extra-articular coexisting conditions that would influence disease management, such as uveitis, psoriasis or inflammatory bowel disease, are not addressed within these guidelines.
- Recommendations are intended to be used by all clinicians caring for persons with JIA and assume that patients do not have contraindications to the recommended pharmacologic treatments.
- Longer-term glucocorticoid therapy in childhood is not appropriate because of its effects on bone health and growth. Thus, wherever glucocorticoids are suggested, recommended treatment should be limited to the lowest effective dose for the shortest duration possible.
- Shared decision-making with families and patients is important when considering treatment options.
Treatment
...Treatm...
...nterventionsHaving trouble viewing table? Ex...
... Oligoa...
...trial of consistent NSAIDs is conditi...
Intra-articular glucocorticoids (IAGCs) are str...
...iamcinolone hexacetonide (THA) is stro...
...orticoids are conditionally recommended against...
...MTX) ( Low , Strong...
...EF, SSZ, HCQ) ( Very low , Strong )6...
...) ( Low , Conditional )6...
..., SSZ, HCQ) ( Very low , Conditi...
...are strongly recommended if there...
...erred biologic DMARD. ( Very low , )608...
...of risk factors for poor outcome (e....
...of validated disease activity measu...
...TMJ Arthritis...
...onsistent NSAIDs is conditionally recomm...
...tionally recommended as part of init...
...s no preferred agent. ( Very low , )608...
...cocorticoids are conditionally recommended aga...
...ional synthetic DMARDs are strongly recomm...
...xate is conditionally recommended a...
...ologic DMARDs are conditionally recomm...
...o preferred biologic agent. ( Very low , )608...
...eration of poor prognostic features (e.g., inv...
...Systemic...
...and discontinuing glucocorticoids is stron...
...discontinuing biologic DMARDs is conditionally...
...e conditionally recommended as initial monothera...
...l glucocorticoids are conditionally re...
...onal synthetic DMARDs are strongly...
...ogic DMARDs (interleukin [IL-1 and IL-6 inhibi...
...e is no preferred agent. ( Very low , )6...
...nd IL-6 inhibitors are strongly recommen...
...S or conventional synthetic DMARDS are st...
...e is no preferred agent. ( Very low ,...
...Systemic JIA Wi...
...-6 inhibitors are conditionally recommended over c...
...ocorticoids are conditionally recomm...
...o preferred agent. ( Very low , )608...
...RDs or conventional synthetic DMARDs...
...s no preferred agent. ( Very low , )608...
...ure 1. Treatment for Oligoarth...
...eatment for TMJ Arthritis
...Treatment for Systemic JIA...