Working to Develop JIA Patient-Centric Guidelines 

The Arthritis Foundation is proud to have partnered with the American College of Rheumatology (ACR) on the release of two guidelines on juvenile idiopathic arthritis (JIA). One guideline focuses on the screening, monitoring and treatment of JIA with associated uveitis. The other guideline provides therapeutic approaches for 3 forms of JIA (non-systemic polyarthritis, sacroilitis and enthesitis).

 

The guideline process included significant input from patients and parents, which was made possible through the Arthritis Foundation and ACR partnership. "We are proud to have been involved in this work and to witness the important contributions of the patient and parent partners," said M. Suz Schrandt, JD, who serves as the director of patient engagement for AF. "Their lived experiences truly helped to guide the project."

Uveitis guidelines 

A common manifestation of JIA is uveitis - which can occur as acute or chronic disease.  

  • Acute anterior uveitis (AAU) is a form of uveitis that typically occurs in children with spondyloarthritis (i.e., those with enthesitis related or psoriatic arthritis). 
  • Chronic anterior uveitis (CAU) develops in 10 to 20% of JIA patients and is usually asymptomatic - there is rarely evidence of inflammation that can be easily seen.  

Important recommendations from the JIA-associated uveitis guideline include 2 strong recommendations and a conditional recommendation. 

Strong recommendations: 

  • Get eye monitoring within one month after each change of topical glucocorticoids rather than monitoring less frequently for kids with controlled uveitis who are tapering or discontinuing topical glucocorticoids.  
  • Provide education regarding the warning signs of AAU for the purpose of decreasing delay in treatment, duration of symptoms, or complications of iritis for kids with spondyloarthritis. 

Conditional recommendation: 

  • Start methotrexate and a monoclonal antibody TNFi immediately (rather than methotrexate as a monotherapy) in kids with severe, active CAU and sight-threating complications.  

JIA polyarthritis guidelines 

A few of the recommendations from the JIA polyarthritis guideline include one strong recommendation and two conditional recommendations. 

Strong recommendation: 

  • A strong recommendation was made against adding chronic low-dose glucocorticoid, regardless of risk factors or disease activity.  

Conditional recommendations: 

  • Non-streroidal anti-inflammatory drugs (NSAIDs) and intraarticular glucocorticoids should each be used as adjunct therapy.  

  • Physical therapy and/or occupational therapy should be recommended for kids with JIA and polyarthritis who have, or are at risk for, functional limitations. 

The American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.  

These recommendations highlight the importance of prompt and effective treatment for children with JIA and polyarthritis, sacroiliitis, and enthesitis. They also support relatively tight disease control, with inactive disease as the goal. While it is anticipated that these recommendations will lead to improved outcomes for children with these forms of JIA, they also emphasize the ongoing need to generate high-quality data about treatment effectiveness in JIA.

Sarah Ringold, MD, a pediatric rheumatologist
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