American College of Rheumatology releases new clinical practice guidelines for juvenile idiopathic arthritis

The American College of Rheumatology has developed new guidelines for the initiation and monitoring of treatments for patients with juvenile idiopathic arthritis.

According to an American College of Rheumatology (ACR) press release, the recommendations are the first juvenile idiopathic arthritis guidelines endorsed by the ACR and were created as a guide for health care providers.

The recommendations include initiating treatment with tumor necrosis factor-alpha (TNF-alpha) inhibitors in children with a history of arthritis in four or fewer joints and significant arthritis despite methotrexate treatment; starting treatment with TNF-alpha inhibitors in children with a history of arthritis in five or more joints and any active arthritis following an adequate methotrexate trial; and treatment with anakinra in those with systemic arthritis and active fever whose treatment requires a second medication in addition to systemic glucocorticoids.

Timothy Beukelman, MD, MSCE, an ACR member and assistant professor of pediatrics at the University of Alabama at Birmingham, led the research team that developed the guidelines. “These recommendations were developed by two distinct panels of international pediatric rheumatology experts using a rigorous methodology,” Beukelman stated in the release.

According to the release, the new recommendations focus on the initiation and safety monitoring of multiple medications used in treating juvenile idiopathic arthritis including:

NSAIDs;
intra-articular glucocorticoid injections;
non-biologic disease-modifying antirheumatic drugs;
biologic disease-modifying antirheumatic drugs; and
systemic glucocorticoids.

To develop the guideline, the research team reviewed more than 200 studies regarding treatment of the condition. Beukelman and colleagues used established processes from the RAND/UCLA Appropriateness Method, which defines appropriate patient care by combining the best available scientific evidence with the collective judgment of leaders in the field.

“Our goal was to provide evidence and consensus-based guidance that reflects the current state of the field and is useful to clinicians of all levels of experience with the treatment of [juvenile idiopathic arthritis] JIA,” Beukelman stated in the release. “The recommendations are important because the treatment of JIA has undergone major changes over the last decade with the introduction of biologic therapeutic agents.”

Reference:
Beukelman, T., et al. Arthritis Care & Research. 2011. doi:10.1002/acr.20460.
Disclosures: The study was funded by the ACR, University of Alabama at Birmingham Deep South Musculoskeletal Center for Education and Research on Therapeutics (Agency for Healthcare Research and Quality. Grant Number: U18-HS016956), National Institutes of Health. Grant Number: 5KL2-RR025776-03, and University of Alabama at Birmingham Center for Clinical and Translational Science.

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