Volume 26, Issue 1, April 2015
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886744931
Mediterr J Rheumatol 2015; 26(1): 17-40
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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. 