Juvenile Idiopathic Arthritis — Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis and Systemic JIA

Publication Date: March 2, 2022

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

...atment...

...InterventionsHaving trouble viewin...


...goarthritis...

...l of consistent NSAIDs is conditionally recommend...

...ra-articular glucocorticoids (IAGCs) are strong...

...hexacetonide (THA) is strongly recommended as t...

...coids are conditionally recommended...

...X) ( Low , Strong )608...

...Q) ( Very low , Strong )608

...w , Conditional )608...

...SZ, HCQ) ( Very low , Conditional )608...

...s are strongly recommended if there is in...

...o preferred biologic DMARD. ( Very low...

...eration of risk factors for poor ou...

...of validated disease activity measures is c...


...J Arthritis

...ial of consistent NSAIDs is conditionally r...

...s are conditionally recommended as part of init...

...here is no preferred agent. ( Very...

...oids are conditionally recommended a...

...entional synthetic DMARDs are stron...

...e is conditionally recommended as a preferred...

...DMARDs are conditionally recommended f...

...erred biologic agent. ( Very low , )608...

...sideration of poor prognostic feat...


...mic JIA Inactive Disease...

...pering and discontinuing glucocorticoids is strong...

...d discontinuing biologic DMARDs is con...


...mic JIA Without MA...

...itionally recommended as initial monotherapy. (...

...ucocorticoids are conditionally recomm...

...l synthetic DMARDs are strongly rec...

...ic DMARDs (interleukin [IL-1 and IL-6...

...e is no preferred agent. ( Very...

...IL-6 inhibitors are strongly recommen...

...or conventional synthetic DMARDS are strong...

...here is no preferred agent. ( Very low ,...


...c JIA With MAS...

...hibitors are conditionally recomme...

...corticoids are conditionally recom...

...ferred agent. ( Very low , )608...

...s or conventional synthetic DMARDs are strongl...

...ere is no preferred agent. ( Very low...


Figure 1. Treatment for Oligoarthriti...


...reatment for TMJ Arthritis...


...igure 3. Treatment for Systemic...