The 2014 Update on the CRA/SPARCC Treatment Recommendations for the Management of SpA for application to JSpA(ERA).
| Recommendation | LOE | SOR |
|---|---|---|
| Nonpharmacological | ||
| 1. Children and adolescents with JIA have reduced aerobic fitness, but can participate in exercise without disease exacerbation. Patients with JSpA(ERA) should be strongly encouraged to participate in regular physical activities that are compatible with the child’s general abilities and development. | I | B |
| 2. Peripheral arthritis and enthesitis involving the foot and ankle are common in JSpA(ERA) and the use of comfortable, cushioning, and supportive foot orthotics should be considered in these patients. | I | B |
| NSAID and analgesics | ||
| 3. Peripheral SpA is more common in JSpA(ERA) and should be managed with an adequate trial of NSAID (1–2 mos) initially. | IV | D |
| 4. Sacroiliitis in JSpA(ERA) can be managed according to the axSpA recommendations. | IV | D |
| Corticosteroids | ||
| 5. No specific modifications. | I | B |
| DMARD | ||
| 6. No specific modifications. | I (SSZ) III (MTX, LEF) | A (SSZ) C (MTX, LEF) |
| Antibiotics | ||
| 7. No specific modifications. | IV | D |
| TNFi | ||
| 8. TNFi are beneficial in JSpA(ERA) and should be prescribed in accordance to the predominantly axial or peripheral SpA recommendations. TNFi available for the treatment of JSpA(ERA) is currently restricted to ETN, ADA, and IFX. | I (IFX, ADA) II (ETN) | A (IFX, ADA) B (ETN) |
| Other biologic agents | ||
| 9. The use of these agents in JSpA(ERA) has not been studied. | IV | D |
| Surgery | ||
| 10. No specific modifications. | IV | D |
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; JIA: juvenile idiopathic arthritis; NSAID: nonsteroidal antiinflammatory drugs; axSpA: axial SpA; DMARD: disease-modifying antirheumatic drugs; SSZ: sulfasalazine; MTX: methotrexate: LEF: leflunomide; TNFi: tumor necrosis factor inhibitors; ETN: etanercept; ADA: adalimumab; IFX: infliximab.