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. 2022 Apr;74(4):553-569.
doi: 10.1002/art.42037. Epub 2022 Mar 1.

2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis

Karen B Onel  1 , Daniel B Horton  2 , Daniel J Lovell  3 , Susan Shenoi  4 , Carlos A Cuello  5 , Sheila T Angeles-Han  3 , Mara L Becker  6 , Randy Q Cron  7 , Brian M Feldman  8 , Polly J Ferguson  9 , Harry Gewanter  10 , Jaime Guzman  11 , Yukiko Kimura  12 , Tzielan Lee  13 , Katherine Murphy  14 , Peter A Nigrovic  15 , Michael J Ombrello  16 , C Egla Rabinovich  6 , Melissa Tesher  17 , Marinka Twilt  18 , Marisa Klein-Gitelman  19 , Fatima Barbar-Smiley  20 , Ashley M Cooper  21 , Barbara Edelheit  22 , Miriah Gillispie-Taylor  23 , Kimberly Hays  24 , Melissa L Mannion  7 , Rosemary Peterson  25 , Elaine Flanagan  26 , Nadine Saad  27 , Nancy Sullivan  28 , Ann Marie Szymanski  29 , Rebecca Trachtman  30 , Marat Turgunbaev  31 , Keila Veiga  32 , Amy S Turner  31 , James T Reston  28
Affiliations

2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis

Karen B Onel et al. Arthritis Rheumatol. 2022 Apr.

Abstract

Objective: To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided.

Methods: We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.

Results: Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional.

Conclusion: This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.

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Figures

Figure 1.
Figure 1.
Treatment algorithm for oligoarthritis.
Figure 2.
Figure 2.
Treatment algorithm for temporomandibular joint arthritis.
Figure 3.
Figure 3.
Treatment algorithm for systemic juvenile idiopathic arthritis.
See this image and copyright information in PMC

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References

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