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Treating Juvenile Idiopathic Arthritis to Target: Recommendations of an international task force.
Annals of the Rheumatic Diseases
  • 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
6-1-2018
URL with Digital Object Identifier
https://doi.org/10.1136/annrheumdis-2018-213030
Disciplines
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.

Citation Information
Angelo Ravelli, Alessandro Consolaro, Gerd Horneff, Ronald M Laxer, et al.. "Treating Juvenile Idiopathic Arthritis to Target: Recommendations of an international task force." Annals of the Rheumatic Diseases Vol. 77 Iss. 6 (2018) p. 819 - 828
Available at: http://works.bepress.com/roberta-berard/26/