2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis
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- Karen B. Onel
- Hospital for Special Surgery New York New York
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- Daniel B. Horton
- Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey
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- Daniel J. Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati Cincinnati Ohio
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- Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington Seattle
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- Carlos A. Cuello
- McMaster University Hamilton Ontario Canada
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- Sheila T. Angeles‐Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati Cincinnati Ohio
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- Mara L. Becker
- Duke University Durham North Carolina
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- Randy Q. Cron
- University of Alabama at Birmingham
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- Brian M. Feldman
- The Hospital for Sick Children Toronto Ontario Canada
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- Polly J. Ferguson
- University of Iowa Carver College of Medicine Iowa City
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- Harry Gewanter
- Children's Hospital of Richmond at VCU Richmond Virginia
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- Jaime Guzman
- BC Children's Hospital Vancouver British Columbia Canada
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- Yukiko Kimura
- Hackensack Meridian School of Medicine Hackensack New Jersey
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- Tzielan Lee
- Stanford University Palo Alto California
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- Katherine Murphy
- Louisiana Department of Health New Orleans
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- Peter A. Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital Boston Massachusetts
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- Michael J. Ombrello
- NIH Bethesda Maryland
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- C. Egla Rabinovich
- Duke University Durham North Carolina
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- Melissa Tesher
- University of Chicago Chicago Illinois
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- Marinka Twilt
- University of Calgary and Alberta Children's Hospital Calgary Alberta Canada
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- Marisa Klein‐Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University Chicago Illinois
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- Fatima Barbar‐Smiley
- Nationwide Children's Hospital Columbus Ohio
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- Ashley M. Cooper
- Children's Mercy Hospital Kansas City Missouri
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- Barbara Edelheit
- Connecticut Children's Medical Center Hartford
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- Miriah Gillispie‐Taylor
- Baylor College of Medicine Houston Texas
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- Kimberly Hays
- Penn State Health Children's Hospital Hershey Pennsylvania
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- Melissa L. Mannion
- University of Alabama at Birmingham
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- Rosemary Peterson
- Dell Children's Medical Center Austin Texas
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- Elaine Flanagan
- Emory University Atlanta Georgia
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- Nadine Saad
- University of Michigan Ann Arbor
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- Nancy Sullivan
- ECRI Institute Plymouth Meeting Pennsylvania
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- Ann Marie Szymanski
- Johns Hopkins All Children's Hospital St. Petersburg Florida
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- Rebecca Trachtman
- Icahn School of Medicine at Mount Sinai New York New York
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- Marat Turgunbaev
- American College of Rheumatology Atlanta Georgia
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- Keila Veiga
- Maria Fareri Children's Hospital Valhalla New York
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- Amy S. Turner
- American College of Rheumatology Atlanta Georgia
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- James T. Reston
- ECRI Institute Plymouth Meeting Pennsylvania
抄録
<jats:sec><jats:title>Objective</jats:title><jats:p>To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision‐making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision‐making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.</jats:p></jats:sec>
収録刊行物
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- Arthritis & Rheumatology
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Arthritis & Rheumatology 74 (4), 553-569, 2022-03
Wiley