Juvenile Idiopathic Arthritis
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
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...Terms and definitionsaHaving trouble viewing...
...entions included in the literature reviewHaving t...
...medication recommendations for children and adole...
...ach recommendation is preceded by the phrase: “...
NSAI...
NSAIDs are conditionally recommended...
DMARD...
...ide (, Moderate )607...
...zine (, Very Low )607...
...utaneous methotrexate is conditionally recom...
...ocorticoids...
...cular glucocorticoids are conditio...
...inolone hexacetonide is strongly r...
...idging therapy with a limited course of or...
...ly recommend against bridging therapy with...
...y recommend against adding chronic...
...ogic DMARDs
...cept, golimumab (, Very Low )607...
abatacept, or tocilizumab (, L...
...limumab (, Moderat...
...bination therapy with a DMARD is strongly r...
...apy and occupational therapy...
...ical therapy (, Low )60...
...cupational therapy (, Very Low )607...
...ble 4. General guidelines for the ini...
...Disease activity (moderate/high and low)...
...ommendation is preceded by the phrase: “In chil...
Initial therapy
...patients
...y with a DMARD is strongly recommended over NSAID...
...trexate monotherapy as initial therapy...
...atients without risk fac...
...apy with a DMARD is conditionally recommende...
...atients with risk fact...
...tial therapy with a DMARD is conditionally r...
...sequent therapy: Low disease activity (...
...ren receiving a DMARD and/or biologic:...
...ating therapy is conditionally recom...
Subsequent therapy: Moderate/high di...
...ient is receiving DMARD monoth...
...ng a biologic to original DMARD is con...
Adding a biologic is conditionally recommend...
...receiving first TNFi (± DMARD):
...iologic (tocilizumab or abatacept) is conditi...
...ient is receiving second biologic:...
...ng TNFi, abatacept, or tocilizumab (depending on...
...ummary of primary recommendations for the initial...
...le 5. Recommendations for the init...
...d adolescents with active sacroiliitis, treatme...
...children and adolescents with active sa...
...s strongly recommended over continued NSAID...
...alazine for patients who have contraindicatio...
...rongly recommend against using metho...
...lucocorticoids
...children and adolescents with active...
Bridging therapy with a limited course o...
...cular glucocorticoid injection of the sacroiliac j...
...ysical ther...
...n and adolescents with sacroiliiti...
...ecommendations for the initial and subs...
...adolescents with active enthesitis, NSAID...
...adolescents with active enthesitis despite t...
...s conditionally recommended over methotrexate or s...
...y with a limited course of oral glucoco...
...ical therapy...
...dren and adolescents with enthesitis who have or a...