Juvenile Idiopathic Arthritis

Publication Date: April 25, 2019

Key Points

Key Points

  • Juvenile arthritis is one of the most common chronic diseases of childhood, with an estimated prevalence of 1 per 1,000 children.
  • Following the exclusion of other known causes of synovitis, the term juvenile idiopathic arthritis (JIA) defines a heterogeneous collection of inflammatory arthritides of unknown etiology with onset prior to age 16 years and a minimum duration of 6 weeks.
  • All forms of JIA are associated with decreased health-related quality of life and risk of permanent joint damage. The disease may persist into adulthood, causing ongoing significant morbidity and impaired quality of life.
  • A number of treatments are available, including nonsteroidal antiinflammatory drugs (NSAIDs), systemic and intra-articular glucocorticoids, and nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs).
  • Prompt initiation of appropriate therapy is of critical importance in preventing permanent damage and improving outcomes.

Treatment

...reatme...

Table 1. Terms and definitionsaHaving...


...ntions included in the literature reviewHaving tro...


...le 3. General medication recommendatio...

...recommendation is preceded by the phrase: “In ch...

NSAIDs

...e conditionally recommended as adjunct therapy....

...MARDs...

...omide (, Moderate )6...

...lazine (, Very Low )6...

...eous methotrexate is conditionally recommen...

...ucocorticoids...

...articular glucocorticoids are conditionally rec...

...one hexacetonide is strongly recommend...

Bridging therapy with a limited cou...

...commend against bridging therapy with a limit...

...ommend against adding chronic low-dose glucoco...

...gic DMARDs...

...olimumab (, Very Low )607...

...cept, or tocilizumab (, Low )607...

...ab (, Moderate )607...

Combination therapy with a DMARD is...

...hysical therapy and occupational therap...

...sical therapy (, Low...

...pational therapy (, Very...


Table 4. General guidelines for the initia...

...ivity (moderate/high and low) as defined by...

...ch recommendation is preceded by the phrase:...

...tial thera...

...patients...

...tial therapy with a DMARD is strongly recommended...

...ethotrexate monotherapy as initial thera...

Patients without risk factor...

...itial therapy with a DMARD is conditionally rec...

...atients with risk facto...

...tial therapy with a DMARD is conditionally reco...

...t therapy: Low disease activity (cJAD...

...en receiving a DMARD and/or biologic:...

...ting therapy is conditionally reco...

...rapy: Moderate/high disease activity (cJADAS-10 >2...

...patient is receiving DMARD monothera...

...ologic to original DMARD is conditionally...

...biologic is conditionally recommended over cha...

...receiving first TNFi (± DMARD):...

...izumab or abatacept) is conditionally re...

...nt is receiving second biolog...

...ing TNFi, abatacept, or tocilizuma...


...igure 1. Summary of primary recommendations for t...


...5. Recommendations for the initial and...

...children and adolescents with active sacroiliitis...

...nd adolescents with active sacroiliitis desp...

...ding TNFi is strongly recommended over continue...

...salazine for patients who have cont...

...recommend against using methotrexate monoth...

Glucocorticoi...

...adolescents with active sacroiliitis d...

...dging therapy with a limited course of o...

...cular glucocorticoid injection of the sacroiliac j...

...ysical thera...

...dren and adolescents with sacroiliitis who...


...mmendations for the initial and subsequent t...

...en and adolescents with active enthesitis, NSA...

...ren and adolescents with active enthesitis despite...

Using a TNFi is conditionally recommended over...

...apy with a limited course of oral glucocortico...

Physical therap...

...children and adolescents with enthe...