medwireNews: The American College of Rheumatology (ACR) has released two updated sets of recommendations for the management of juvenile idiopathic arthritis (JIA).
The first guideline provides recommendations on the pharmacologic management of oligoarthritis, temporomandibular joint arthritis, and systemic JIA with or without macrophage activation syndrome. This guideline forms an update to previous recommendations from 2011 and 2013, and a key change is the endorsement of early DMARD use.
“For many years, treatment of JIA consisted of corticosteroids, non-steroidal anti-inflammatory drugs [NSAIDs], physical therapy, bracing and surgery,” said lead author Karen Onel (Hospital for Special Surgery, New York, USA) in a press release.
Conversely, the current recommendations “stress the early use of conventional synthetic and biologic DMARDs and the avoidance of glucocorticoids and NSAIDs,” she added, noting that “for systemic JIA the guidelines suggest using biologic DMARDs as a first line.”
The authors also address treatment tapering and discontinuation in patients with inactive systemic JIA, as well as other aspects of JIA management, such as factors impacting treatment choice. They caution that the evidence for all recommendations was of low or very low quality, with 16 of the 25 recommendations being conditional.
The second guideline provides recommendations for nonpharmacologic management of JIA – including occupational therapy, physical therapy, and an age-appropriate diet – as well as medication monitoring, immunizations, and imaging. Similar to the pharmacologic management guideline, all evidence used in this guideline was graded as low or very low quality, and 23 of 33 recommendations are conditional.
Both guidelines, published simultaneously in Arthritis Care & Research and Arthritis & Rheumatology, emphasize the importance of shared decision-making between healthcare providers and patients/caregivers.
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