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2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis.
Arthritis Care Res (Hoboken). 2019 06; 71(6):717-734.AC

Abstract

OBJECTIVE

To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis.

METHODS

The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions.

RESULTS

Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies.

CONCLUSION

This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

Authors+Show Affiliations

Seattle Children's Hospital, Seattle, Washington.Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.University of Alabama, Birmingham.Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.McMaster University, Hamilton, Ontario, Canada.Children's Mercy Hospital, Kansas City, Missouri.National Institutes of Health, Bethesda, Maryland.The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.University of Iowa Carver College of Medicine, Iowa City.Children's Hospital of Richmond, Virginia Commonwealth University, Richmond.BC Children's Hospital, Vancouver, British Columbia, Canada.Columbia University Medical Center, New York, New York.Brigham & Women's Hospital and Boston Children's Hospital, Boston, Massachusetts.National Institutes of Health, Bethesda, Maryland.Medical University of South Carolina, Charleston.University of Alabama, Birmingham.Duke University, Durham, North Carolina.The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.Boston Children's Hospital, Boston, Massachusetts.Medical University of South Carolina, Charleston.American College of Rheumatology, Atlanta, Georgia.ECRI Institute, Plymouth Meeting, Pennsylvania.National Institutes of Health, Bethesda, Maryland.American College of Rheumatology, Atlanta, Georgia.American College of Rheumatology, Atlanta, Georgia.ECRI Institute, Plymouth Meeting, Pennsylvania.

Pub Type(s)

Journal Article
Practice Guideline
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

31021516

Citation

Ringold, Sarah, et al. "2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis." Arthritis Care & Research, vol. 71, no. 6, 2019, pp. 717-734.
Ringold S, Angeles-Han ST, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care Res (Hoboken). 2019;71(6):717-734.
Ringold, S., Angeles-Han, S. T., Beukelman, T., Lovell, D., Cuello, C. A., Becker, M. L., Colbert, R. A., Feldman, B. M., Ferguson, P. J., Gewanter, H., Guzman, J., Horonjeff, J., Nigrovic, P. A., Ombrello, M. J., Passo, M. H., Stoll, M. L., Rabinovich, C. E., Schneider, R., Halyabar, O., ... Reston, J. (2019). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care & Research, 71(6), 717-734. https://doi.org/10.1002/acr.23870
Ringold S, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care Res (Hoboken). 2019;71(6):717-734. PubMed PMID: 31021516.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. AU - Ringold,Sarah, AU - Angeles-Han,Sheila T, AU - Beukelman,Timothy, AU - Lovell,Daniel, AU - Cuello,Carlos A, AU - Becker,Mara L, AU - Colbert,Robert A, AU - Feldman,Brian M, AU - Ferguson,Polly J, AU - Gewanter,Harry, AU - Guzman,Jaime, AU - Horonjeff,Jennifer, AU - Nigrovic,Peter A, AU - Ombrello,Michael J, AU - Passo,Murray H, AU - Stoll,Matthew L, AU - Rabinovich,C Egla, AU - Schneider,Rayfel, AU - Halyabar,Olha, AU - Hays,Kimberly, AU - Shah,Amit Aakash, AU - Sullivan,Nancy, AU - Szymanski,Ann Marie, AU - Turgunbaev,Marat, AU - Turner,Amy, AU - Reston,James, Y1 - 2019/04/25/ PY - 2018/08/31/received PY - 2019/02/27/accepted PY - 2019/4/26/pubmed PY - 2020/2/25/medline PY - 2019/4/26/entrez SP - 717 EP - 734 JF - Arthritis care & research JO - Arthritis Care Res (Hoboken) VL - 71 IS - 6 N2 - OBJECTIVE: To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis. METHODS: The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. RESULTS: Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. CONCLUSION: This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies. SN - 2151-4658 UR - https://www.unboundmedicine.com/medline/citation/31021516/2019_American_College_of_Rheumatology/Arthritis_Foundation_Guideline_for_the_Treatment_of_Juvenile_Idiopathic_Arthritis:_Therapeutic_Approaches_for_Non_Systemic_Polyarthritis_Sacroiliitis_and_Enthesitis_ L2 - https://doi.org/10.1002/acr.23870 DB - PRIME DP - Unbound Medicine ER -