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
...sses of Interventions Nonste...
... Oligoarthritis...
...istent NSAIDs is conditionally recommended as part...
...icular glucocorticoids (IAGCs) are strongly...
...riamcinolone hexacetonide (THA) is strongly rec...
...icoids are conditionally recommended...
(MTX) ( Low , Strong )608
...Z, HCQ) ( Very low , Strong )608...
...( Low , Conditional...
...Q) ( Very low , Conditional )608...
...ogic DMARDs are strongly recommende...
...s no preferred biologic DMARD. ( Very l...
...ideration of risk factors for poor o...
...e of validated disease activity me...
...sistent NSAIDs is conditionally recommen...
...onditionally recommended as part of initial...
...e is no preferred agent. ( Very low ,...
...oids are conditionally recommended against as...
...synthetic DMARDs are strongly recommended for...
...s conditionally recommended as a preferred...
...iologic DMARDs are conditionally rec...
...ere is no preferred biologic agent....
...f poor prognostic features (e.g., involvement o...
...Sys...
...continuing glucocorticoids is stro...
...apering and discontinuing biologic...
...Sys...
NSAIDs are conditionally recommended as i...
...coids are conditionally recommended against as ini...
...ntional synthetic DMARDs are strongly recommende...
...(interleukin [IL-1 and IL-6 inhibit...
...is no preferred agent. ( Very lo...
...IL-6 inhibitors are strongly recommended...
...DMARDS or conventional synthetic DMA...
...no preferred agent. ( Very low , )608...
...System...
...L-6 inhibitors are conditionally rec...
Glucocorticoids are conditionally recomme...
...preferred agent. ( Very low , )608...
...ARDs or conventional synthetic DMARDs are strongl...
...referred agent. ( Very low , )608...
...igure 1. Treatment for Oligoarthritis...
...igure 2. Treatment for TMJ Arthritis...
...Treatment for Systemic JIA