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

Publication Date: March 3, 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

Treatme...

...s of InterventionsHaving trouble viewing table?...


 Oligoarthriti...

...istent NSAIDs is conditionally recommended a...

...rticular glucocorticoids (IAGCs) ar...

...xacetonide (THA) is strongly recommended as...

...orticoids are conditionally recommended agains...

...Low , Strong )608...

(LEF, SSZ, HCQ) ( Very low , Strong )608

...w , Conditional )608...

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

...ologic DMARDs are strongly recomme...

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

...f risk factors for poor outcome (e.g.,...

...alidated disease activity measures i...


...MJ Arthriti...

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

...are conditionally recommended as par...

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

Oral glucocorticoids are conditionally...

...onal synthetic DMARDs are strongly recommended for...

...te is conditionally recommended as a preferred age...

...Ds are conditionally recommended for...

...is no preferred biologic agent. ( Very lo...

...deration of poor prognostic features (e.g., i...


...stemic JIA Inactive...

...ng and discontinuing glucocorticoid...

Tapering and discontinuing biologic DMARDs is cond...


...stemic JIA Without MAS

...IDs are conditionally recommended as initial mono...

...al glucocorticoids are conditionally recommend...

...nventional synthetic DMARDs are strong...

...s (interleukin [IL-1 and IL-6 inhibitors]) are con...

...is no preferred agent. ( Very low , )608

...hibitors are strongly recommended over...

...RDS or conventional synthetic DMAR...

...no preferred agent. ( Very low , )6...


...ystemic JIA Wit...

...nd IL-6 inhibitors are conditionally recommende...

...rticoids are conditionally recommen...

...no preferred agent. ( Very low...

...ogic DMARDs or conventional synthe...

...o preferred agent. ( Very low , )6...


...Treatment for Oligoarthri...


...re 2. Treatment for TMJ Arthrit...


...e 3. Treatment for Systemic J...