In the U.S., there are nearly 300,000 children with juvenile arthritis and other rheumatic illnesses according to estimates from the American College of Rheumatology (ACR). For pediatric patients with systemic juvenile idiopathic arthritis (JIA), effective treatment for this disabling disease is imperative. New treatment recommendations that guide physicians caring for children with systemic JIA are now published in the ACR journals, Arthritis & Rheumatism and Arthritis Care & Research.
Systemic JIA is defined by the International League of Associations for Rheumatology as arthritis in one or more joints for at least six weeks in children sixteen years of age or younger. The arthritis is accompanied or preceded by fever for at least two-weeks that is daily (“quotidian”) for at least 3 of those days, with one or more of the following symptoms: red rash (evanescent erythematous rash), enlarged liver, spleen or lymph nodes, and inflammation of the tissue lining (serositis) of the lungs, heart, or stomach. Medical evidence suggests that systemic JIA accounts for 4% to 15% of all JIA cases.
Each year the ACR reviews its current guidelines to ensure that they are up to date. In 2012, the ACR determined that an update to the 2011 JIA recommendations - specifically for treatment of systemic JIA - was needed. A new team that included researchers who worked on the original JIA guideline was assembled to develop the 2013 update.
Investigators, led by Dr. Pamela Weiss from Children’s Hospital of Philadelphia in Pennsylvania and Dr. Sarah Ringold from the Seattle Children’s Hospital in Washington, conducted a systematic review of medical literature through January 2013.
The new recommendations for systemic JIA are based upon more than 1,200 clinical scenarios and include recommendations for use of the following medications:
Non-steroidal anti-inflammatory drugs (NSAIDs)
Intravenous immunoglobulin (IVIG)
Tumor necrosis factor alpha (TNFα) inhibitors
*New addition to the 2013 update
They include treatment options for patients with and without active systemic disease, along with varying degrees of inflammation of the joint lining (synovitis), as well as recommendations for repeat TB screening for JIA patients receiving biologics. Dr. Weiss concludes, “The 2013 recommendations address specific disease characteristics and reflect the commitment to enhancing care of children with systemic JIA.”
This work was funded by the American College of Rheumatology, and investigators’ time was supported in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Disease, NIH (grant1-K23-AR059749-01A) and the Agency for Healthcare Research and Quality (grant K12HS019482).
Full citation: “2013 Update of the 2011 American College of Rheumatology Recommendations for the Treatment of Juvenile Idiopathic Arthritis. Recommendations for the Medical Therapy of Children with Systemic Juvenile Idiopathic Arthritis and Tuberculosis Screening Among Children Receiving Biologic Medications.” Sarah Ringold, Pamela F. Weiss, Timothy Beukelman, Esi Morgan DeWitt, Norman T. Ilowite, Yukiko Kimura, Ronald M. Laxer, Daniel J. Lovell, Peter A. Nigrovic, Angela Byun Robinson and Richard K. Vehe. Arthritis & Rheumatism (DOI: 10.1002/art.38092). Arthritis Care & Research (DOI: 10.1002/acr.22087); Published Online: September 24, 2013.
About the Journals
Arthritis & Rheumatism is an official journal of the American College of Rheumatology (ACR) and covers all aspects of inflammatory disease. The American College of Rheumatology is the professional organization whose members share a dedication to healing, preventing disability, and curing the more than 100 types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members include practicing physicians, research scientists, nurses, physical and occupational therapists, psychologists, and social workers. The journal is published by Wiley on behalf of the ACR.
Arthritis Care & Research is an official journal of the American College of Rheumatology (ACR), and the Association of Rheumatology Health Professionals (ARHP), a division of the College. Arthritis Care & Research is a peer-reviewed journal that publishes both original research and review articles that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with arthritis and related disorders, major topics are evidence-based practice studies, clinical problems, practice guidelines, health care economics, health care policy, educational, social, and public health issues, and future trends in rheumatology practice. The journal is published by Wiley on behalf of the ACR.
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