Protocols on classification, monitoring and therapy in children’s rheumatology (PRO-KIND): results of the working group Polyarticular juvenile idiopathic arthritis

Abstract

ObjectiveSeveral effective pharmacologic treatment options for polyarticual juvenile idiopathic arthritis (JIA) have emerged but initial treatment is heterogeneous in Germany. Therefore, the German Society of Pediatric Rheumatolgy has established a commission to develop consensus “Protocols on classification, monitoring and therapy in children's rheumatology (PRO-KIND)” to harmonize diagnostic and treatment approaches for new-onset JIA in Germany.MethodsA set of definitions for in- and exclusion, diagnostic workup, parameters for the evaluation of disease activity criteria, therapeutic options, medication dosing, monitoring recommendations, targets, definitions of a therapy failure and four therapeutic algorithms developed by a working group were agreed by web based survey to which all members of the GKJR have been invited. A final protocol with 4 consensus treatment plans (CTP) was agreed in a face-to-face consensus conferences employing modified nominal group technique.ResultsThe initial 17 definitions and recommendations for new-onset polyarticular JIA agreed by the working group reached >80% agreement in a web survey in 68 German paediatric rheumatologist. Four CTPs were developed based on treatment strategies for the first 12 months of therapy, as well as definitions for clinical and laboratory monitoring. The CTPs include a step-up plan (nonbiologic Disease-modifying antirheumatic drug [DMARD] followed by a biologic), a combination plan (combination of nonbiologic and biologic after failure of initial DMARD), an intensive pulse corticosteroid scheme in parallel with a DMARD followed by combination therapy and a multiple corticosteroids joint injections strategy in a treat to target approach. Step up will be guided by a treat to target strategy to reach a JADAS-improvement at month 3, acceptable disease at month 6 or 9 and JADAS remission or at least JADAS minimal disease activity at month 12.ConclusionStandardized baseline work-up, disease activity evaluation and a definition of a treat to target approach will result in better health outcomes for polyarticular JIA patients. Four CTPs were developed for new-onset polyarticular JIA, which coupled with data collection at defined intervals will be evaluated and improved to optimize management of polyarticular JIA. Harmonization of treatment will be the basis for future comparative effectiveness research.Electronic supplementary materialThe online version of this article (10.1186/s12969-017-0206-9) contains supplementary material, which is available to authorized users.

Therapie der juvenilen idiopathischen Arthritis (JIA)

“…Im Gegensatz zu international zunehmend verbreiteten und auch in Deutschland vorgeschlagenen Consensus Treatment Plans (CTP), bei denen verschiedene Therapieansätze für die Behandlung definierter rheumatischer Erkrankungen vorgeschlagen und geprüft werden, verfolgt die Leitlinienarbeit ein anderes Ziel [24][25][26][27]. Es wird die vorhandene Evidenz für z. T. etablierte oder auch zugelassene Behandlungsmodalitäten in den Fokus genommen, während die o. g. CTP keine Placebo-kontrollierten Effektivitätsprüfungen einzelner Substanzen vornehmen, sondern verschiedene Behandlungsansätze prüfen.…”

Differenzialdiagnosen bei Schmerzen am Bewegungsapparat – Teil 2

“…4). Für jeden Subtyp der JIA erarbeitet die GKJR zurzeit einen jeweiligen Consensus-Treatment-Plan (CTP), in denen verschiedene Therapieschemata hinsichtlich ihrer Wirksamkeit und Verträglichkeit miteinander verglichen werden sollen [14].…”

Versorgung von Kindern, Jugendlichen und jungen Erwachsenen mit juveniler idiopathischer Arthritis

“…Besonders deutlich werden die gemeinsamen Anstrengungen für eine kosteneffektive und patienten-orientierte Therapie in der Initiative "ProKind" der GKJR. Um das Vorgehen an den kinderrheumatologischen Einrichtungen zu harmonisieren, werden von der Kommission "ProKind" der GKJR evidenz-und konsensbasierte Empfehlungen für die einzelnen Formen der JIA erarbeitet [23,24]. Diese Protokolle zur Diagnostik und Therapie spiegeln mit verschiedenen Behandlungspfaden das derzeit hierzulande von Kinder-und Jugendrheumatologen favorisierte Vorgehen wider.…”