TY - JOUR
T1 - 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis
T2 - 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
N1 - Funding Information:
Dr. Beukelman has received consulting fees from Bristol-Myers Squibb, Sobi, UCB, and Novartis (less than $10,000 each). Dr. Lovell has received consulting fees from AstraZeneca, Amgen, Abbott, Wyeth Pharmaceuticals, Pfizer, Ho 贀mann-La Roche, Novartis, UCB, Takeda, Janssen, GlaxoSmithKline, Boehringer 阀ngelheim, Celgene, Bristol-Myers Squibb, and AbbVie (less than $10,000 each). Dr. Nigrovic has received consulting fees from Bristol-Myers Squibb, Pfizer, AbbVie, Novartis, and Sobi (less than $10,000 each) and research grants from Sobi, Novartis, AbbVie, and Genentech (in support of the FROST study of systemic J 阀A through CARRA). Dr. Stoll has received speaking fees from Novartis (less than $10,000). Dr. Rabinovich has received consulting fees from AbbVie (less than $10,000). Dr. Schneider has received consulting fees from Novartis and Sobi (less than $10,000 each). No other disclosures relevant to this article were reported.
Funding Information:
We thank Alexei Grom, MD, Ron Laxer, MD, FRCP, Mindy Lo, MD, PhD, Sampath Prahalad, MD, MSc, Meredith Riebschleger, MD, Angela Byun Robinson, MD, MPH, Grant Schulert, MD, PhD, Heather Tory, MD, and Richard Vehe, MD, for serving on the Expert Panel. We thank Suzanne Schrandt with the Arthritis Foundation for her involvement throughout the guideline development process. We thank our patient representative for adding valuable perspectives. We thank Liana Fraenkel, MD, MPH, for leading the Patient Panel meeting, as well as the patients and parents who participated in this meeting: Linda Aguiar, Jake Anderson, Samantha Bell, Julianne Capron, Stephanie Dodunski, Holly Dwyer, Stephanie Kweicein, Carolina Mejia Pena, and Nikki Reitz, LCSW. We thank the American College of Rheumatology staff, including Regina Parker for assistance in organizing the face-to-face meetings and coordinating the administrative aspects of the project, and Robin Lane for assistance with manuscript preparation. We thank Janet Waters for help in developing the literature search strategy and performing the literature search and updates, and Janet Joyce for peer-reviewing the literature search strategy.
Funding Information:
Supported by the American College of Rheumatology and the Arthritis Foundation. Dr. Angeles-Han’s work was supported by the N 阀H (grant K23-EY-021760 from the National Eye 阀nstitute), the Rheumatology Research Foundation, and the Cincinnati Children’s Hospital Medical Center Research 阀nnovation and Pilot fund. Drs. Colbert and Ombrello’s work was supported by the N 阀H (grants AR-041184 and AR-041198, respectively, from the 阀ntramural Research Program of the National 阀nstitute of Arthritis and Musculoskeletal and Skin Diseases). Dr. Ferguson’s work was supported by the N 阀H (grant AR-059-703). Dr. Nigrovic’s work was supported by the Fundación Bechara.
Publisher Copyright:
© 2019, American College of Rheumatology
PY - 2019/6
Y1 - 2019/6
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.
AB - 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.
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U2 - 10.1002/art.40884
DO - 10.1002/art.40884
M3 - Article
C2 - 31021537
AN - SCOPUS:85065010870
SN - 2326-5191
VL - 71
SP - 846
EP - 863
JO - Arthritis and Rheumatology
JF - Arthritis and Rheumatology
IS - 6
ER -