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
Treatme...
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.... Interventions included in the literature revie...
...neral medication recommendations for children a...
...commendation is preceded by the phrase: “In ch...
NSAIDs
...itionally recommended as adjunct the...
...ARDs
...ide (, Moderate )607...
...azine (, Very Low )6...
Using subcutaneous methotrexate is condition...
...ucocorticoi...
Intra-articular glucocorticoids are con...
...mcinolone hexacetonide is strongly recom...
...y with a limited course of oral glucocortico...
...commend against bridging therapy with...
...recommend against adding chronic low...
...ologic DMARDs...
...rcept, golimumab (, Very...
...r tocilizumab (, Low )607...
adalimumab (, Moderat...
Combination therapy with a DMARD is...
...apy and occupational therapy...
...therapy (, Low )607...
...tional therapy (, Very Low )607...
...e 4. General guidelines for the initial and sub...
...se activity (moderate/high and low) as...
...recommendation is preceded by the phrase:...
...itial therapy
...patients
...l therapy with a DMARD is strongly reco...
...ate monotherapy as initial therapy is condit...
...ients without risk facto...
...l therapy with a DMARD is condition...
...s with risk factors:...
...therapy with a DMARD is conditionally recommende...
...herapy: Low disease activity (cJADAS-10...
...ceiving a DMARD and/or biologic:...
...ng therapy is conditionally recommended ov...
...apy: Moderate/high disease activity (cJADAS...
...tient is receiving DMARD monotherap...
...ding a biologic to original DMARD...
...ng a biologic is conditionally recom...
...patient is receiving first TNFi (...
...iologic (tocilizumab or abatacept) is cond...
...is receiving second biologic:...
...abatacept, or tocilizumab (depending on prior bio...
...mary of primary recommendations for the...
.... Recommendations for the initial and subsequ...
...en and adolescents with active sacr...
...children and adolescents with active sacroilii...
...strongly recommended over continued NSAID m...
Using sulfasalazine for patients who have contrain...
...y recommend against using methotrex...
...ucocorticoi...
In children and adolescents with active sac...
...ng therapy with a limited course of...
...-articular glucocorticoid injectio...
...ysical therapy
...n and adolescents with sacroiliitis...
...endations for the initial and subseq...
...n and adolescents with active enthesitis, NSAID...
...adolescents with active enthesitis despite treatm...
...ing a TNFi is conditionally recommended over met...
...rapy with a limited course of oral glu...
...sical therapy...
...d adolescents with enthesitis who have or...