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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
Author(s) -
Ringold Sarah,
AngelesHan Sheila T.,
Beukelman Timothy,
Lovell Daniel,
Cuello Carlos A.,
Becker Mara L.,
Colbert Robert A.,
Feldman Brian M.,
Ferguson Polly J.,
Gewanter Harry,
Guzman Jaime,
Horonjeff Jennifer,
Nigrovic Peter A.,
Ombrello Michael J.,
Passo Murray H.,
Stoll Matthew L.,
Rabinovich C. Egla,
Schneider Rayfel,
Halyabar Olha,
Hays Kimberly,
Shah Amit Aakash,
Sullivan Nancy,
Szymanski Ann Marie,
Turgunbaev Marat,
Turner Amy,
Reston James
Publication year - 2019
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.40884
Subject(s) - medicine , guideline , enthesitis , polyarthritis , sacroiliitis , physical therapy , arthritis , intensive care medicine , population , disease , rheumatology , pathology , psoriatic arthritis , environmental health
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.