Sumary of JIA guidelines push for timely immunization, early biologic use, fewer corticosteroids:
- Despite minimal evidence available, authors of the 2020 ACR juvenile idiopathic arthritis guidelines emerged with nearly 50 recommendations, emphasizing early use of biologics, regular immunizations and reduced reliance on corticosteroids..
- Susan Shenoi, MS, MBBS, RhMSUS, interim division chief of rheumatology at Seattle Children Hospital, said in her presentation, noting that the document covers oligoarthritis, temporomandibular joint (TMJ) arthritis and systemic JIA with or without macrophage activation syndrome (MAS)..
- The group also wanted to develop recommendations for the same therapeutic armamentarium in TMJ arthritis and develop similar screening guidelines in systemic JIA..
- “Then, [we wanted to] develop guidelines around medication monitoring, imaging, infection screening, immunization, and non-pharmacologic treatments of children with JIA in general,”.
- Guideline Development The group also aimed to develop a document that was “timely, relevant and feasible in clinical practice,”.
- Namely, the group developed Population- Intervention- Comparator- Outcomes (PICO) questions, conducted a rigorous literature review, employed the grading of recommendations assessment, development and evaluation (GRADE) methodology to make decisions and included a patient panel..
- “Similar to the RA guidelines, although we know that corticosteroids are important, especially for children as regards growth stunting and weakened bones, we really try to avoid their use whenever possible so that was a critical part of what we presented,”.
- For oligoarthritis with fewer than five joints involved, intra-articular glucocorticoids are recommended as part of initial therapy, while triamcinolone acetonide is recommended as a preferred therapy, according to Onel….