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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.

Publication ,  Journal Article
Ringold, S; Angeles-Han, ST; Beukelman, T; Lovell, D; Cuello, CA; Becker, ML; Colbert, RA; Feldman, BM; Ferguson, PJ; Gewanter, H; Guzman, J ...
Published in: Arthritis Rheumatol
June 2019

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.

Duke Scholars

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Published In

Arthritis Rheumatol

DOI

EISSN

2326-5205

Publication Date

June 2019

Volume

71

Issue

6

Start / End Page

846 / 863

Location

United States

Related Subject Headings

  • Tumor Necrosis Factor Inhibitors
  • Sacroiliitis
  • Physical Therapy Modalities
  • Occupational Therapy
  • Injections, Intra-Articular
  • Humans
  • Glucocorticoids
  • Enthesopathy
  • Arthritis, Juvenile
  • Arthritis
 

Citation

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ICMJE
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Ringold, S., Angeles-Han, S. T., Beukelman, T., Lovell, D., Cuello, C. A., Becker, M. L., … 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 Rheumatol, 71(6), 846–863. https://doi.org/10.1002/art.40884
Ringold, Sarah, Sheila T. Angeles-Han, Timothy Beukelman, Daniel Lovell, Carlos A. Cuello, Mara L. Becker, Robert A. Colbert, 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 Rheumatol 71, no. 6 (June 2019): 846–63. https://doi.org/10.1002/art.40884.
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 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Rheumatol. 2019 Jun;71(6):846–863.
Journal cover image

Published In

Arthritis Rheumatol

DOI

EISSN

2326-5205

Publication Date

June 2019

Volume

71

Issue

6

Start / End Page

846 / 863

Location

United States

Related Subject Headings

  • Tumor Necrosis Factor Inhibitors
  • Sacroiliitis
  • Physical Therapy Modalities
  • Occupational Therapy
  • Injections, Intra-Articular
  • Humans
  • Glucocorticoids
  • Enthesopathy
  • Arthritis, Juvenile
  • Arthritis