HealthDay News — In two 2021 American College of Rheumatology guidelines, published online March 1 in Arthritis & Rheumatology, updated recommendations are presented for the pharmacologic and nonpharmacologic management of juvenile idiopathic arthritis (JIA).

Karen B. Onel, MD, from the Hospital for Special Surgery in New York City, and colleagues conducted a systematic literature review and updated the guidelines for pharmacologic management of JIA. The recommendations are based on clinical phenotypes of JIA, similar to those published in 2019. The authors provide recommendations for initial and subsequent treatment of JIA with oligoarthritis, temporomandibular joint arthritis, and systemic JIA. None of the recommendations were supported by moderate- or high-quality evidence. The need for individualizing treatment was stressed by patients/caregivers, and the importance of shared decision-making was emphasized.

In a second set of recommendations, Onel and colleagues focused on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, regardless of JIA phenotype. The authors recommended use of physical therapy and occupational therapy interventions; an age-appropriate, well-balanced diet; laboratory monitoring for medications; and widespread immunization us. They also emphasized the importance of shared decision making with patients/caregivers. The low quality of evidence supporting most of these recommendations underscores the importance of clinical judgment and emphasizes the need for more high-quality evidence to support current practice and improve disease management.

“Not every decision will be appropriate for every patient, which is why it was so instrumental to receive input from both patients and caregivers when creating these recommendations,” Onel said in a statement.

Several authors from both guidelines disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text – Pharmacologic Management (subscription or payment may be required)

Abstract/Full Text – Nonpharmacologic Management (subscription or payment may be required)