Treating juvenile idiopathic arthritis to target: recommendations of an international task force

Abstract

Recent therapeutic advances in juvenile idiopathic arthritis (JIA) have made remission an achievable goal for most patients. Reaching this target leads to improved outcomes. The objective was to develop recommendations for treating JIA to target. A Steering Committee formulated a set of recommendations based on evidence derived from a systematic literature review. These were subsequently discussed, amended and voted on by an international Task Force of 30 paediatric rheumatologists in a consensus-based, Delphi-like procedure. Although the literature review did not reveal trials that compared a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated development of recommendations. The group agreed on six overarching principles and eight recommendations. The main treatment target, which should be based on a shared decision with parents/patients, was defined as remission, with the alternative target of low disease activity. The frequency and timeline of follow-up evaluations to ensure achievement and maintenance of the target depend on JIA category and level of disease activity. Additional recommendations emphasise the importance of ensuring adequate growth and development and avoiding long-term systemic glucocorticoid administration to maintain the target. All items were agreed on by more than 80% of the members of the Task Force. A research agenda was formulated. The Task Force developed recommendations for treating JIA to target, being aware that the evidence is not strong and needs to be expanded by future research. These recommendations can inform various stakeholders about strategies to reach optimal outcomes for JIA.

Factors impacting referral of JIA patients to a tertiary level pediatric rheumatology center in North India: a retrospective cohort study

“…In this group despite ongoing treatments at first PR assessment, patients had a more aggressive disease with higher AJC, more cervical involvement, high ESR and more inappropriate schooling. Only 4.8% were in remission whereas the median disease duration was 13.8 months (IQR [3.8, 34.5]) which is not in line with international recommendations advocating clinical remission within 6 months following treatment onset [25]. Facing this common problem of shortage of PRst in low and middle countries, JAMLess recommendations advocate that in the absence of PRsts, patients should be assessed by clinicians knowledgeable and skilled in caring for children with rheumatic disorders who, ideally, are affiliated with an established rheumatology clinical network [19].…”

“…Clinical remission was defined as the absence of signs and symptoms of inflammatory disease activity, including extra-articular manifestations [25].…”

A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care

“…While many of these measures build upon existing published measures, some modifications were made to better reflect Canadian practice and/or current guidelines. Furthermore, a new measure was proposed to ensure measurement of disease activity with the cJADAS to optimize efforts in treating JIA to target [29].…”

Toward Accelerated Authorization and Access to New Medicines for Juvenile Idiopathic Arthritis

“…Although meaningful to patients and parents, the ACR definition of clinically inactive disease does not incorporate the patient perception of disease status, which is a weakness. Strictly applied criteria for clinically inactive disease also describe a high level of response that may be difficult to attain during a registration trial . In addition, clinically inactive disease and JADAS inactive disease are not equivalent states, which could be a problem when using either outcome measure in a clinical trial and when comparing results .…”