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
...Tre...
...nd definitionsa Term De...
...2. Interventions included in the li...
...General medication recommendations for childre...
Each recommendation is preceded by the phr...
...NSAIDs...
...are conditionally recommended as adj...
...DMAR...
...flunomide (, Moderate...
...ulfasalazine (, Very...
...ubcutaneous methotrexate is condit...
...Glucocorticoids...
...a-articular glucocorticoids are conditionally rec...
...mcinolone hexacetonide is strongly recomm...
...idging therapy with a limited course of oral...
Conditionally recommend against br...
...ongly recommend against adding chronic low-dose g...
...Biolo...
...pt, golimumab (, Very Low )...
...pt, or tocilizumab (, Low )607
...b (, Moderate )607
...on therapy with a DMARD is strongly reco...
...Physical therapy and o...
...hysical therapy (, Low...
...tional therapy (, Very Low )607
...Table 4. Gene...
...sease activity (moderate/high and low) as d...
...recommendation is preceded by the phrase: “In...
...Initial th...
...All pa...
...therapy with a DMARD is strongly recommended over...
...otrexate monotherapy as initial therapy is con...
...tial therapy with a DMARD is conditiona...
...Patients with risk f...
...ial therapy with a DMARD is conditionall...
...Subsequent the...
...For children r...
Escalating therapy is conditionally r...
...Subseque...
...If...
...ding a biologic to original DMARD is...
...logic is conditionally recommended over changing t...
...If patient is...
...(tocilizumab or abatacept) is con...
...If patient i...
...sing TNFi, abatacept, or tocilizumab...
...e 1. Summary of primary recommenda...
...Tabl...
...dren and adolescents with active sacro...
...In children and adolesce...
...NFi is strongly recommended over continued NS...
...ulfasalazine for patients who have contrai...
...y recommend against using methotrexate monotherap...
...Gl...
...In children and adole...
...therapy with a limited course of oral glucocort...
...a-articular glucocorticoid injection of the...
...Physical the...
...adolescents with sacroiliitis who have or ar...
...Table 6....
...and adolescents with active enthesitis, NSAI...
...In children an...
...s conditionally recommended over methotrexate...
...ging therapy with a limited course of...
...Physical therap...
...d adolescents with enthesitis who have or are at...