2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis

Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis

Sarah Ringold, Sheila T. Angeles-Han, Timothy Beukelman, Daniel Lovell, Carlos A. Cuello, Mara L. Becker, Robert A. Colbert, Brian M. Feldman, Polly J. Ferguson, Harry Gewanter, Jaime Guzman, Jennifer Horonjeff, Peter A. Nigrovic, Michael J. Ombrello, Murray H. Passo, Matthew L. Stoll, C. Egla Rabinovich, Rayfel Schneider, Olha Halyabar, Kimberly Hays & 6 others Amit Aakash Shah, Nancy Sullivan, Ann Marie Szymanski, Marat Turgunbaev, Amy Turner, James Reston

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)846-863
Number of pages18
JournalArthritis and Rheumatology
Volume71
Issue number6
DOIs
StatePublished - Jun 1 2019

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Sacroiliitis
Juvenile Arthritis
Arthritis
Guidelines
Caregivers
Therapeutics
Patient Preference
Consensus
Decision Making
Antirheumatic Agents
Group Processes
Occupational Therapy
Politics
Biological Products
Glucocorticoids
Comorbidity
Anti-Inflammatory Agents

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Rheumatology
  • Immunology

Cite this

Ringold, Sarah ; Angeles-Han, Sheila T. ; Beukelman, Timothy ; Lovell, Daniel ; Cuello, Carlos A. ; Becker, Mara L. ; Colbert, Robert A. ; Feldman, Brian M. ; Ferguson, Polly J. ; Gewanter, Harry ; Guzman, Jaime ; Horonjeff, Jennifer ; Nigrovic, Peter A. ; Ombrello, Michael J. ; Passo, Murray H. ; Stoll, Matthew L. ; Rabinovich, C. Egla ; Schneider, Rayfel ; Halyabar, Olha ; Hays, Kimberly ; Shah, Amit Aakash ; Sullivan, Nancy ; Szymanski, Ann Marie ; Turgunbaev, Marat ; Turner, Amy ; Reston, James. / 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis : Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. In: Arthritis and Rheumatology. 2019 ; Vol. 71, No. 6. pp. 846-863.
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title = "2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis",
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.",
author = "Sarah Ringold and Angeles-Han, {Sheila T.} and Timothy Beukelman and Daniel Lovell and Cuello, {Carlos A.} and Becker, {Mara L.} and Colbert, {Robert A.} and Feldman, {Brian M.} and Ferguson, {Polly J.} and Harry Gewanter and Jaime Guzman and Jennifer Horonjeff and Nigrovic, {Peter A.} and Ombrello, {Michael J.} and Passo, {Murray H.} and Stoll, {Matthew L.} and Rabinovich, {C. Egla} and Rayfel Schneider and Olha Halyabar and Kimberly Hays and Shah, {Amit Aakash} and Nancy Sullivan and Szymanski, {Ann Marie} and Marat Turgunbaev and Amy Turner and James Reston",
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Ringold, S, Angeles-Han, ST, Beukelman, T, Lovell, D, Cuello, CA, Becker, ML, Colbert, RA, Feldman, BM, Ferguson, PJ, Gewanter, H, Guzman, J, Horonjeff, J, Nigrovic, PA, Ombrello, MJ, Passo, MH, Stoll, ML, Rabinovich, CE, Schneider, R, Halyabar, O, Hays, K, Shah, AA, Sullivan, N, Szymanski, AM, Turgunbaev, M, Turner, A & 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 and Rheumatology, vol. 71, no. 6, pp. 846-863. https://doi.org/10.1002/art.40884

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis : Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. / Ringold, Sarah; Angeles-Han, Sheila T.; Beukelman, Timothy; Lovell, Daniel; Cuello, Carlos A.; Becker, Mara L.; Colbert, Robert A.; Feldman, Brian M.; Ferguson, Polly J.; Gewanter, Harry; Guzman, Jaime; Horonjeff, Jennifer; Nigrovic, Peter A.; Ombrello, Michael J.; Passo, Murray H.; Stoll, Matthew L.; Rabinovich, C. Egla; Schneider, Rayfel; Halyabar, Olha; Hays, Kimberly; Shah, Amit Aakash; Sullivan, Nancy; Szymanski, Ann Marie; Turgunbaev, Marat; Turner, Amy; Reston, James.

In: Arthritis and Rheumatology, Vol. 71, No. 6, 01.06.2019, p. 846-863.

Research output: Contribution to journalArticle

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

PY - 2019/6/1

Y1 - 2019/6/1

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.

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