medwireNews: An international taskforce has developed consensus recommendations for treating juvenile idiopathic arthritis (JIA) to target.
In their six overarching principles and eight specific recommendations, Angelo Ravelli (Istituto G. Gaslini, Genoa, Italy) and colleagues define the main treatment target in JIA as clinical remission, meaning “the absence of signs and symptoms of inflammatory disease activity, including extra-articular manifestations.”
They note that this target may be difficult to achieve in some patients, particularly those with a long duration of disease, and recommend that minimal disease activity “may be an alternative target” for such patients.
The authors emphasize that these treatment targets, as well as therapeutic strategies, should be based on individual patient characteristics and shared decisions between patients or their parents and healthcare providers.
Ravelli and colleagues advocate that the long-term use of glucocorticoids to achieve treatment targets should be avoided, but otherwise do not provide advice on specific medication use.
Instead, “the present recommendations […] are primarily intended to provide expert guidance on general treatment approaches,” and “should be applicable and ideally adhered to in all regions and countries, irrespective of medication availability,” they write in the Annals of the Rheumatic Diseases.
The experts also specify that disease activity should be monitored regularly using a validated instrument, with the frequency of assessments based on disease characteristics, and state that treatment should be adjusted until the target is reached. All of the authors agreed unanimously that inhibiting inflammation “is the most important goal in the treatment of JIA.”
These recommendations were developed following a systematic literature review. Ravelli and a steering committee of five other experts formulated draft recommendations, which were then discussed, modified, and voted on by a taskforce of 30 pediatric rheumatologists from North and Latin America, Africa, Asia, Australia, and Europe.
Although the systematic review “provided indirect evidence regarding an optimised approach to therapy that facilitated development of recommendations,” the authors caution that no randomized trial has evaluated a treat-to-target approach compared with conventional therapy in JIA.
As a result, “the individual recommendations can only be regarded as consensus-based expert opinion and, therefore, call for further research in the field,” they conclude.
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