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Volume 26, Issue 1, April 2015

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Mediterr J Rheumatol 2015; 26(1): 17-40
Recommendations for treating various types of established Juvenile Idiopathic Arthritis
Abstract
The therapeutic regimens, recommended by the ACR (2011-2013) for Juvenile idiopathic Arthritis (JIA), refer to “5  treatment groups”, according to the number and type of  the joints affected, the presence or absence  of poor prognostic factors in combination with the physician’s global assessment for the disease activity (MDVAS global) and the presence of systemic features.  1st therapeutic group:   Patients with persistent  oligoarthritis.  2nd  therapeutic group: Patients with persistent polyarthritis.  3rd  therapeutic group:Patients with clinical or imaging indications of active  sacroiliitis, as patients with enthesitis related arthritis or psoriatic arthritis or any other type of arthritis with active sacroiliac arthritis. The therapeutic strategy is schematically depicted for the first 3 groups.   The systemic JIA therapeutic groups are  divided into the “systemic JIA with active systemic features and  varying degrees of synovitis (4th group)” and the “systemic JIA without active systemic features and  varying degrees of synovitis (5th group)”. For the 4th therapeutic group : Initial treatment with corticosteroids (CS) with or without NSAIDs; in case of non-response within 2 weeks, synthetic or biologic DMARDs are  administered, based on the criteria aforementioned; in case of predominant systemic features, initial treatment with anti-IL-1  or   anti- IL-6 and in case of predominant polyarthritis, synthetic DMARDs followed by anti-TNFs is recommended.  Forthe 5th therapeutic group:Initial treatment with NSAIDs and intra-articular steroids; in case of non-response within 1 month, synthetic or biologic DMARDs are administered based on the number of joints affected.  Thus, in oligoarthritis,  synthetic  DMARDs first, followed by  biologic ones in case of non-response  within 3 months, are administered; in polyarthritis,  biologic DMARDs are administered.