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

作者：Sarah Ringold, Sheila T. Angeles‐Han, Timothy Beukelman, Daniel J. Lovell, Carlos A. Cuello‐García, Mara L. Becker, Robert A. Colbert, Brian M. Feldman, Polly J. Ferguson, Harry L. Gewanter, Jaime Guzmán, Jennifer Horonjeff, Peter A. Nigrović, Michael J. Ombrello, Murray H. Passo, Matthew L. Stoll, C. Egla Rabinovich, Rayfel Schneider, Olha Halyabar, Kimberly A. Hays, Amit Shah, Nancy Sullivan, Ann Marie Szymanski, Marat Turgunbaev, Amy S. Turner, James Reston · 发表于：Arthritis Care & Research · 年份：2019 · DOI：10.1002/acr.23870 · 被引用次数：483 · 研究领域：Autoimmune and Inflammatory Disorders Research、Spondyloarthritis Studies and Treatments、Rheumatoid Arthritis Research and Therapies

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...