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
Treatme...
...lasses of InterventionsHaving trouble v...
...ligoarthritis...
...al of consistent NSAIDs is conditionally recommen...
...articular glucocorticoids (IAGCs)...
...nolone hexacetonide (THA) is strongly r...
...ucocorticoids are conditionally recommende...
...( Low , Strong )...
...SSZ, HCQ) ( Very low , Strong )...
...X) ( Low , Condition...
...HCQ) ( Very low , Conditional )...
...ogic DMARDs are strongly recommende...
...preferred biologic DMARD. ( Very low , )608...
...eration of risk factors for poor outcome (e.g., i...
...e of validated disease activity measures is...
...Arthriti...
...al of consistent NSAIDs is conditiona...
...AGCs are conditionally recommended as p...
...preferred agent. ( Very low , )608...
...ucocorticoids are conditionally recomme...
...entional synthetic DMARDs are strongly recomm...
...conditionally recommended as a prefer...
...s are conditionally recommended for inadequ...
...s no preferred biologic agent. ( Very l...
...deration of poor prognostic features (e...
...JIA Inactive Disease...
...g and discontinuing glucocorticoid...
...apering and discontinuing biologic DMARDs is...
...stemic JIA Witho...
...IDs are conditionally recommended as...
...ral glucocorticoids are conditionally recommended...
...ional synthetic DMARDs are strongly recommen...
...logic DMARDs (interleukin [IL-1 and IL-6 inhibitor...
...preferred agent. ( Very low , )608...
...IL-6 inhibitors are strongly recommended...
...MARDS or conventional synthetic DMARDS ar...
...no preferred agent. ( Very low , )608...
...c JIA With MAS...
...nd IL-6 inhibitors are conditionally recom...
...ids are conditionally recommended as pa...
...no preferred agent. ( Very low , )608...
...iologic DMARDs or conventional synthetic DMARDs...
...no preferred agent. ( Very low , )608...
...e 1. Treatment for Oligoarthritis...
...gure 2. Treatment for TMJ A...
...igure 3. Treatment for System...