Elsevier

Clinical Immunology

Volume 142, Issue 2, February 2012, Pages 176-193
Clinical Immunology

Evidence and consensus based GKJR guidelines for the treatment of juvenile idiopathic arthritis

https://doi.org/10.1016/j.clim.2011.10.003Get rights and content
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Abstract

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and adolescents. Immunomodulatory drugs are used frequently in its treatment. Using the nominal group technique (NGT) and Delphi method, we created a multidisciplinary, evidence- and consensus-based treatment guideline for JIA based on a systematic literature analysis and three consensus conferences. Conferences were headed by a professional moderator and were attended by representatives who had been nominated by their scientific societies or organizations. 15 statements regarding drug therapy, symptomatic and surgical management were generated. It is recommended that initially JIA is treated with NSAID followed by local glucocorticoids and/or methotrexate if unresponsive. Complementing literature evidence with long-standing experience of caregivers allows creating guidelines that may potentially improve the quality of care for children and adolescents with JIA.

Highlights

► JIA pathogenesis involves dysregulation of both adaptive and innate immunity. ► Drugs interacting with TNFα and IL-1β are increasingly being used in JIA treatment. ► An evidence-based multidisciplinary consensus was created. ► Evidence and consensus-based guidelines may be a useful tool to standardize JIA care.

Abbreviations

ACR
American College of Rheumatology
AE
adverse events
AGREE
appraisal of guidelines for research and evaluation
AWMF
Association of the Scientific Medical Associations
Bw
bodyweight
CAPS
cryopyrin-associated periodic syndromes
CD
cluster of differentiation
CIOMS
Council for International Organizations of Medical Sciences
CTLA-4
cytotoxic T-lymphocyte antigen 4
DELBI
German instrument for methodological guideline appraisal
DMARDs
disease modifying anti-rheumatic drugs
EBM
evidence based medicine
EMA
European Medical Agency
EULAR
European League against Rheumatism
FDA
Food and Drug Administration
GC
glucocorticoids
GKJR
German Society for Pediatric Rheumatology
GPs
general practitioners
IgG
immunoglobulin G
IL
interleukin
ILAR
International League of Associations for Rheumatology
JDM
juvenile dermatomyositis
JIA
juvenile idiopathic arthritis
MAS
macrophage activation syndrome
Max
maximum
MTX
methotrexate
NGT
nominal group technique
NSAID
nonsteroidal anti-inflammatory drug(s)
SCT
stem cell transplantation
SLE
systemic lupus erythematodes
SoJIA
systemic onset of juvenile idiopathic arthritis
TNF
tumor necrosis factor
TPMT
thiopurinmethyltransferase

Keywords

Juvenile idiopathic arthritis
Treatment
Guideline
Consensus
Children and adolescents

Cited by (0)

1

Contributed equally.