Treating Juvenile Idiopathic Arthritis to Target: Recommendations of an international task force.

Authors

Angelo Ravelli, Università degli Studi di Genova
Alessandro Consolaro, Università degli Studi di Genova
Gerd Horneff, Asklepios Klinik Sankt Augustin
Ronald M Laxer, University of Toronto
Daniel J Lovell, University of Cincinnati
Nico M Wulffraat, University of Utrecht
Jonathan D Akikusa, Murdoch Children's Research Institute
Sulaiman M Al-Mayouf, Alfaisal University
Jordi Antón, Universitat de Barcelona
Tadej Avcin, University of Ljubljana
Roberta A Berard, Western University
Michael W Beresford, University of Liverpool
Ruben Burgos-Vargas, Hospital General de México Eduardo Liceaga
Rolando Cimaz, Azienda Ospedaliero Universitaria Meyer
Fabrizio De Benedetti, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù
Erkan Demirkaya, Western University
Dirk Foell, University of Muenster
Yasuhiko Itoh, Nippon Medical School
Pekka Lahdenne, Helsinki University Hospital
Esi M Morgan, University of Cincinnati
Pierre Quartier, Necker-Enfants Malades Hospital
Nicolino Ruperto, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini
Ricardo Russo, Hospital de Pediatría Garrahan
Claudia Saad-Magalhães, São Paulo State University
Sujata Sawhney, Sir Ganga Ram Hospital
Christiaan Scott, University of Cape Town
Susan Shenoi, University of Washington
Joost F Swart, University of Utrecht
Yosef Uziel, Meir Medical Center
Sebastiaan J Vastert, University of Utrecht
Josef S Smolen, Medical University of Vienna

Document Type

Article

Publication Date

6-2018

Journal

Annals of the Rheumatic Diseases

Volume

77

Issue

6

First Page

819

Last Page

828

URL with Digital Object Identifier

https://doi.org/10.1136/annrheumdis-2018-213030

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.