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

...reatment...

Table 1. Terms and definitionsaHaving troubl...


...ventions included in the literature revie...


...able 3. General medication recommendation...

...endation is preceded by the phrase: “In...

...AIDs

...conditionally recommended as adju...

...MARDs...

...flunomide (, Moderat...

...salazine (, Very Low...

...bcutaneous methotrexate is conditionally r...

...ocorticoids

...ular glucocorticoids are condition...

...xacetonide is strongly recommended over triamc...

...with a limited course of oral gluco...

...ly recommend against bridging therapy with...

...commend against adding chronic low-dose glucocor...

...iologic DM...

...rcept, golimumab (, Very L...

...batacept, or tocilizumab (, Low...

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

...nation therapy with a DMARD is str...

...al therapy and occupational therapy...

...therapy (, Low )607...

...ccupational therapy (, Very L...


...ble 4. General guidelines for the initial and...

...vity (moderate/high and low) as defined by the c...

...ecommendation is preceded by the p...

...tial therapy

...l patients...

...therapy with a DMARD is strongly recomm...

...ing methotrexate monotherapy as initi...

...without risk factors:b...

...y with a DMARD is conditionally reco...

...with risk factors:...

...ial therapy with a DMARD is conditiona...

...erapy: Low disease activity (cJADAS-...

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

...ing therapy is conditionally recom...

...rapy: Moderate/high disease activity (cJADA...

...ient is receiving DMARD monotherapy:...

...ogic to original DMARD is conditionally...

...biologic is conditionally recommende...

...f patient is receiving first TNFi (±...

...ilizumab or abatacept) is conditio...

...patient is receiving second biologic:

...i, abatacept, or tocilizumab (depend...


...Summary of primary recommendations for the...


...ecommendations for the initial and...

...en and adolescents with active sacroiliitis, tre...

...adolescents with active sacroiliitis despite t...

...strongly recommended over continued...

...g sulfasalazine for patients who have contraind...

...recommend against using methotrexate monothera...

...cocorticoids

...en and adolescents with active sacroiliitis desp...

...ging therapy with a limited course of oral gluc...

...rticular glucocorticoid injection of th...

Physical therap...

...and adolescents with sacroiliitis who h...


...commendations for the initial and subseque...

...and adolescents with active enthesitis, NSAID...

...adolescents with active enthesitis despi...

...is conditionally recommended over methotrexate...

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

...hysical thera...

...hildren and adolescents with enthesitis who...