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
...Treat...
...able 1. Terms and definitionsaHaving trouble...
...rventions included in the literature reviewHaving...
...e 3. General medication recommendations for child...
...ion is preceded by the phrase: “In children and...
...NSAIDs...
...nditionally recommended as adjunct thera...
...DMARDs...
...omide (, Moderate )607...
...ulfasalazine (, Very Low )607...
...cutaneous methotrexate is conditionally recomme...
...Glucocorticoids...
...lar glucocorticoids are conditionally re...
...iamcinolone hexacetonide is strongly...
...ging therapy with a limited course of...
...lly recommend against bridging therapy with a l...
...mmend against adding chronic low-dose glucocortic...
...Bi...
etanercept, golimumab (, Very Low...
...pt, or tocilizumab (, Low )607...
...mumab (, Moderate )607...
...mbination therapy with a DMARD is strongly...
...Physical t...
...therapy (, Low )607
...ccupational therapy (, Very Low...
...Table 4. General g...
...ivity (moderate/high and low) as defined by...
...ommendation is preceded by the phrase: “In chil...
...Initial therapy...
...All patients...
...nitial therapy with a DMARD is strongly recom...
...trexate monotherapy as initial therap...
...Pat...
...tial therapy with a DMARD is condi...
Pat...
...with a DMARD is conditionally recommended over...
...Subsequent therapy:...
For chil...
...ting therapy is conditionally recommended over n...
Subseq...
...If patient is...
...a biologic to original DMARD is conditional...
...iologic is conditionally recommended ove...
...If patient is re...
...c (tocilizumab or abatacept) is condit...
...If patient is...
...i, abatacept, or tocilizumab (depending...
...ry of primary recommendations for the...
...Table 5. Recommendat...
...dren and adolescents with active sacroiliitis, t...
...In children...
...ding TNFi is strongly recommended over c...
...asalazine for patients who have contraindicatio...
...gly recommend against using methotrexate monot...
...Glucocorticoids...
...In children and...
...ing therapy with a limited course of oral...
...ticular glucocorticoid injection of...
...Physical therapy...
...d adolescents with sacroiliitis who have o...
...Tab...
...children and adolescents with active enthesi...
...In children a...
Using a TNFi is conditionally recommended over m...
...rapy with a limited course of oral glucocorticoids...
...P...
...nd adolescents with enthesitis who have or are a...