2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis

Angeles‐Han, Sheila T.; Ringold, Sarah; Beukelman, Timothy; Lovell, Daniel J.; Cuello, Carlos A.; Becker, Mara L.; Colbert, Robert A.; Feldman, Brian M.; Holland, Gary N.; Ferguson, Polly J.; Gewanter, Harry L.; Guzman, Jaime; Horonjeff, Jennifer; Nigrović, Peter A.; Ombrello, Michael J.; Passo, Murray H.; Stoll, Matthew L.; Rabinovich, C. Egla; Sen, H. Nida; Schneider, Rayfel; Halyabar, Olha; Hays, Kimberly A.; Shah, Amit; Sullivan, Nancy; Szymanski, Ann Marie; Turgunbaev, Marat; Turner, Amy S.; Reston, James

doi:10.1002/art.40885

Cited by 78 publications

(72 citation statements)

References 54 publications

(62 reference statements)

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“…The American Telemedicine Association “Operating Procedures for Pediatric Telehealth” (endorsed by the AAP) serves as an operational reference and educational tool regarding appropriate telehealth care for pediatric patients (25). For ophthalmologic surveillance in children at high risk for chronic uveitis or personal history of uveitis, the task force agreed that ongoing in‐person ophthalmology evaluation is strongly recommended, due to the risk of asymptomatic uveitis and the long‐term sequelae that can result from undetected uveitis in children with PRD (26). The task force also agreed that all patients with PRD should receive routine vaccinations (unless contraindicated), including the annual influenza vaccine, on or as close to schedule as possible.…”

Section: Resultsmentioning

confidence: 99%

American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID‐19 Pandemic: Version 1

Wahezi

Rubinstein

et al. 2020

Arthritis & Rheumatology

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Objective To provide clinical guidance to rheumatology providers who treat children with pediatric rheumatic disease (PRD) in the context of the coronavirus disease 2019 (COVID‐19) pandemic. Methods The task force, consisting of 7 pediatric rheumatologists, 2 pediatric infectious disease physicians, 1 adult rheumatologist, and 1 pediatric nurse practitioner, was convened on May 21, 2020. Clinical questions and subsequent guidance statements were drafted based on a review of the queries posed by the patients as well as the families and healthcare providers of children with PRD. An evidence report was generated and disseminated to task force members to assist with 3 rounds of asynchronous, anonymous voting by email using a modified Delphi approach. Voting was completed using a 9‐point numeric scoring system with predefined levels of agreement (categorized as disagreement, uncertainty, or agreement, with median scores of 1–3, 4–6, and 7–9, respectively) and consensus (categorized as low, moderate, or high). To be approved as a guidance statement, median vote ratings were required to fall into the highest tertile for agreement, with either moderate or high levels of consensus. Results The task force drafted 33 guidance statements, which were voted upon during the second and third rounds of voting. Of these 33 statements, all received median vote ratings within the highest tertile of agreement and were associated with either moderate consensus (n = 6) or high consensus (n = 27). Statements with similar recommendations were combined, resulting in 27 final guidance statements. Conclusion These guidance statements have been generated based on review of the available literature, indicating that children with PRD do not appear to be at increased risk for susceptibility to SARS–CoV‐2 infection. This guidance is presented as a “living document,” recognizing that the literature on COVID‐19 is rapidly evolving, with future updates anticipated.

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Section: Resultsmentioning

confidence: 99%

American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID‐19 Pandemic: Version 1

Wahezi

Rubinstein

et al. 2020

Arthritis & Rheumatology

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“…The goal of this guideline project was to provide updated recommendations for juvenile non‐systemic polyarthritis, sacroiliitis, and enthesitis, incorporating recently published data and utilizing the GRADE methodology. Recommendations for the treatment of chronic and acute JIA‐associated uveitis were developed concomitantly and are presented separately .…”

Section: Introductionmentioning

confidence: 99%

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non‐Systemic Polyarthritis, Sacroiliitis, and Enthesitis

Ringold

Angeles‐Han

Beukelman

et al. 2019

Arthritis Care & Research

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287

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Objective To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non‐systemic polyarthritis, sacroiliitis, or enthesitis. Methods The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. Results Thirty‐nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease‐modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. Conclusion This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision‐making process that accounts for patients’ values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

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“…To demonstrate the need for additional medications for the treatment of JIA, this study used a new definition, based on clinical parameters (PhGA, PtGA, and AJC) and the sequential use of ≥2 bDMARDs. The definition was developed a priori by 2 authors (HIB and DJL) and provides a conservative estimate of medication need because the current target of JIA treatment is clearly not met (2,3). This is because patients whose well‐being is moderately impaired due to JIA (PtGA ≥3) or who have a PhGA of ≥3 and/or an AJC of ≥3, clearly have not achieved inactive disease status (2,3).…”

Section: Discussionmentioning

confidence: 99%

“…The definition was developed a priori by 2 authors (HIB and DJL) and provides a conservative estimate of medication need because the current target of JIA treatment is clearly not met (2,3). This is because patients whose well‐being is moderately impaired due to JIA (PtGA ≥3) or who have a PhGA of ≥3 and/or an AJC of ≥3, clearly have not achieved inactive disease status (2,3). However, even if we had excluded PtGA from the definition of chronically uncontrolled JIA, >24% of children could still be considered to have a need for additional medications.…”

Section: Discussionmentioning

confidence: 99%

“…Besides nonsteroidal antiinflammatory drugs, corticosteroid joint injections, and synthetic disease‐modifying antirheumatic drugs (DMARDs) such as methotrexate, biologic DMARDs (bDMARDs) are used to control active arthritis. Current JIA treatment guidelines recommend the use of bDMARDs as part of the early treatment of patients with polyarticular and systemic JIA (2,3).…”

Section: Introductionmentioning

confidence: 99%

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New Medications Are Needed for Children With Juvenile Idiopathic Arthritis

Brunner

Schanberg

Kimura

et al. 2020

Arthritis & Rheumatology

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Objective To document the need for additional Food and Drug Administration (FDA)–approved medications for the treatment of juvenile idiopathic arthritis (JIA). Methods The electronic medical records of JIA patients treated at Cincinnati Children's Hospital Medical Center (CCHMC) and data from JIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry were included in this study. Unmet medication need was defined in 2 ways: (a) the presence of chronically uncontrolled JIA, defined as a physician global assessment of JIA activity ≥3 (on a 0–10 scale, where 0 = inactive) OR ≥3 joints with active arthritis OR a patient global assessment of well‐being ≥3 (on a 0–10 scale, where 0 = very well), despite sequential use of ≥2 biologic disease‐modifying antirheumatic drugs (bDMARDs); and (b) the use of ≥1 bDMARD not approved for any JIA category. Results At CCHMC, 829 of 1,599 JIA patients (52%) were treated with ≥1 bDMARD, and 304 (19%) had been exposed to ≥1 unapproved bDMARD. In the CARRA Registry, 4,766 of 7,379 children (65%) had received ≥1 bDMARD, and 1,122 (15%) had been prescribed ≥1 unapproved bDMARD. Of those children treated with ≥2 bDMARDs for whom complete data were available, 52% (255 of 487) at CCHMC and 45% (527 of 1,159) in the CARRA Registry had chronically uncontrolled JIA despite the use of ≥2 bDMARDs. Conclusion Despite the availability of bDMARDs currently approved for JIA, there is persistent need for additional therapies to control JIA signs and symptoms. Since FDA approval is critical to ensure access to bDMARDs, the study and licensing of new medications is critical to address the unmet medication need and to further improve JIA outcomes.

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2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis

Cited by 78 publications

References 54 publications

American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID‐19 Pandemic: Version 1

American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID‐19 Pandemic: Version 1

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non‐Systemic Polyarthritis, Sacroiliitis, and Enthesitis

New Medications Are Needed for Children With Juvenile Idiopathic Arthritis

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