2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis.
Anti-Inflammatory Agents, Non-Steroidal
/ therapeutic use
Antirheumatic Agents
/ therapeutic use
Arthritis
/ therapy
Arthritis, Juvenile
/ therapy
Enthesopathy
/ therapy
Glucocorticoids
/ therapeutic use
Humans
Injections, Intra-Articular
Occupational Therapy
Physical Therapy Modalities
Sacroiliitis
/ therapy
Tumor Necrosis Factor Inhibitors
/ therapeutic use
Journal
Arthritis & rheumatology (Hoboken, N.J.)
ISSN: 2326-5205
Titre abrégé: Arthritis Rheumatol
Pays: United States
ID NLM: 101623795
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
31
08
2018
accepted:
27
02
2019
pubmed:
26
4
2019
medline:
7
1
2020
entrez:
26
4
2019
Statut:
ppublish
Résumé
To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis. 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. 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. 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.
Identifiants
pubmed: 31021537
doi: 10.1002/art.40884
pmc: PMC6561114
mid: NIHMS1017427
doi:
Substances chimiques
Anti-Inflammatory Agents, Non-Steroidal
0
Antirheumatic Agents
0
Glucocorticoids
0
Tumor Necrosis Factor Inhibitors
0
Types de publication
Journal Article
Practice Guideline
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
846-863Subventions
Organisme : Intramural NIH HHS
ID : ZIA AR041198
Pays : United States
Organisme : Rheumatology Research Foundation
Pays : International
Organisme : NEI NIH HHS
ID : K23 EY021760
Pays : United States
Organisme : Intramural NIH HHS
ID : ZIA AR041184-01
Pays : United States
Organisme : NIH HHS
ID : AR-059-703
Pays : United States
Organisme : Intramural NIH HHS
ID : ZIA AR041184
Pays : United States
Organisme : Intramural NIH HHS
ID : ZIA AR041198-01
Pays : United States
Organisme : NIAMS NIH HHS
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019, American College of Rheumatology.
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