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 HaysAmit Aakash Shah, Nancy Sullivan, Ann Marie Szymanski, Marat Turgunbaev, Amy Turner, James Reston

Research output: Contribution to journalArticle

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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 2019

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All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Rheumatology
  • Immunology

Cite this

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 and Rheumatology, 71(6), 846-863. https://doi.org/10.1002/art.40884