The 2014 Update on the CRA/SPARCC Treatment Recommendations for the Management of SpA for application to JSpA(ERA).
| Recommendation | LOE | SOR |
|---|---|---|
| General management principles | ||
| 1. JSpA(ERA) additionally requires a multidisciplinary family-centered approach to promote normal growth, social development, and physical function in the child or adolescent. | IV | D |
| Ethical considerations | ||
| 2. In consideration of the limited clinical trials in the pediatric population compared to adults, access to therapeutics including some extremely expensive therapies should be based on the highest available standard of evidence-based medicine as well as the best interests of the child. | IV | D |
| Target groups for treatment recommendations | ||
3. In JSpA(ERA), these management recommendations are additionally intended for:
| IV | D |
| Wait time recommendations | ||
| 4. As peripheral SpA is more common in JSpA(ERA), persistent joint or entheseal symptoms > 4 weeks should be screened for the presence of JSpA by a pediatric rheumatologist within 6 weeks of referral. | IV | D |
| 5. axSpA symptoms in JSpA(ERA) should be expanded to include back or buttock pain. Patients with axial symptoms > 4 weeks duration should be screened for the presence of JSpA(ERA) by a pediatric rheumatologist within 6 weeks of referral. | IV | D |
| Disease monitoring | ||
| 6. Radiologic findings in the spine at disease onset is infrequent in JSpA(ERA). Hip involvement is also more common in JSpA(ERA) and confers a poor prognostic factor. Initial MRI imaging should include the pelvis and hips. Additional sites to be imaged by MRI to be determined by pediatric rheumatologist. Whole-body MRI should be considered for early detection of peripheral and axial involvement in JSpA(ERA). | I (MRI SI joints) III (whole-body MRI) | A (MRI SI joints) C (whole-body MRI) |
CRA: Canadian Rheumatology Association; SPARCC: Spondyloarthritis Research Consortium of Canada; SpA: spondyloarthritis; JSpA: juvenile SpA; ERA: enthesitis-related arthritis; LOE: level of evidence; SOR: strength of recommendation; axSpA: axial SpA; MRI: magnetic resonance imaging; SI: sacroiliac.