American College of Rheumatology issues recommendations for treating, monitoring JIA

The American College of Rheumatology has released recommendations for the treatment of children with juvenile idiopathic arthritis (JIA).

The large research team conducted a systematic review of the literature from 1966 through October 2009. More than 200 articles on JIA were included. The recommendations were developed using processes from the Research and Development/University of California at Los Angeles (RAND/UCLA) Appropriateness Method.

The recommendations focus on initiating frequently used and commonly available therapeutic agents for treating JIA, including nonsteroidal anti-inflammatory drugs, intra-articular glucocorticoid injections, nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs), and systemic glucocorticoids.

The recommendations provide detailed therapy regimens for each treatment group. Among the key recommendations is starting treatment with tumor necrosis factor (TNF)-a inhibitors (eg, adalimumab, etanercept, infliximab) in those with a history of arthritis in 4 or fewer joints regardless of any treatment with methotrexate and with TNF-a inhibitors in those who have a history of arthritis in 5 or more joints after a trial of methotrexate. Treatment should be commenced with anakinra, a biologic DMARD, in those with systemic arthritis and active fever who need a second medication in addition to systemic glucocorticoids.

Specific safety monitoring interventions for children treated for JIA also are provided.

The society expects to update its recommendations in 2012.

Beukelman T, Patkar NM, Saag KG, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res. 2011;63(4):465-482.