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
...atment...
...ses of InterventionsHaving trouble viewing tabl...
...goarthritis...
A trial of consistent NSAIDs is con...
...ular glucocorticoids (IAGCs) are strongly recommen...
...one hexacetonide (THA) is strongly recommended...
Oral glucocorticoids are conditionally reco...
...TX) ( Low , Stron...
...SZ, HCQ) ( Very low , Strong )6...
...) ( Low , Conditional...
...F, SSZ, HCQ) ( Very low , Condition...
...gic DMARDs are strongly recommended if there is...
...here is no preferred biologic DMARD....
...of risk factors for poor outcome (e.g., involve...
Use of validated disease activity measures i...
...Arthritis...
...consistent NSAIDs is conditionally recomme...
...itionally recommended as part of ini...
...no preferred agent. ( Very low ,...
...al glucocorticoids are conditional...
...synthetic DMARDs are strongly recommen...
...te is conditionally recommended as a preferred age...
...logic DMARDs are conditionally recommended...
...here is no preferred biologic agent. ( Very lo...
Consideration of poor prognostic features (...
...ic JIA Inactive Disease...
...discontinuing glucocorticoids is strongly...
...discontinuing biologic DMARDs is condition...
...JIA Without MAS...
...s are conditionally recommended as initial mon...
...rticoids are conditionally recommended agains...
...onal synthetic DMARDs are strongly recommended a...
...s (interleukin [IL-1 and IL-6 inhibitors]) are con...
...re is no preferred agent. ( Very low ,...
...inhibitors are strongly recommended...
...ARDS or conventional synthetic DMARDS are stro...
There is no preferred agent. ( Very...
...emic JIA With MAS...
...d IL-6 inhibitors are conditionally...
...s are conditionally recommended as par...
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...ic DMARDs or conventional synthetic DMARDs are...
There is no preferred agent. ( V...
.... Treatment for Oligoarthriti...
...2. Treatment for TMJ Arthri...
...reatment for Systemic JIA