The American College of Rheumatology Releases Updated Guidelines for Treatment of Juvenile Idiopathic Arthritis

ATLANTA – The American College of Rheumatology (ACR) released updated guidelines for the treatment and management of juvenile idiopathic arthritis (JIA). These guidelines are companions to previously updated JIA guidelines released by the ACR in 2019 and 2022 and this update covers several types of juvenile idiopathic arthritis including polyarthritis, oligoarthritis, TMJ arthritis, enthesitis and dactylitis. Juvenile idiopathic arthritis related uveitis was also addressed as well as selected topics in non-pharmacologic management and imaging.

“The guidelines encourage early use of DMARDs with attention paid to risk factors that would suggest the need for early escalation of treatment. To that end, use of biologic DMARDs without the requirement of “failure” of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was supported. Any required waiting period is too long if a child is not doing well,” said Karen Onel, MD, Chief of the Pediatric Rheumatology Division at the Hospital for Special Surgery in New York and the lead investigator of the guidelines. “Balancing treatment with careful screening for side-effects will allow for the best outcomes.”

The overarching goals of the updated guidelines are to promote early and aggressive treatment of JIA that preserves function and maximizes quality of life, encourage timely screening and monitoring to prevent articular and extra-articular damage, and facilitate effective shared decision-making among clinicians, patients, and caregivers.

“Many children in the US and around the world do not have access to expert pediatric rheumatology care. These guidelines should assist not only pediatric rheumatologists but adult rheumatologists and pediatricians in choosing best treatment for children with JIA.” said Dr. Onel. “Recommendations supporting the use of oral over subcutaneous methotrexate is a change from previous standard of care. Continued decreased reliance on NSAIDs and glucocorticoids has been emphasized. Recommendations have been made for mental health care in keeping with recent ACR guidance.

Like many other ACR guidelines, the updated guidelines for JIA were developed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, which creates rigorous standards for judging the quality of the literature available and assigns strengths to the recommendations. The papers containing the full list of recommendations and supporting evidence are available on the ACR’s guideline page.

Media Contact
Teri Arnold
Director, Public Relations & Communications
757-272-7002
tarnold@rheumatology.org

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About the American College of Rheumatology
Founded in 1934, the American College of Rheumatology (ACR) is a not-for-profit, professional association committed to advancing the specialty of rheumatology that serves nearly 10,500 physicians, health professionals, researchers and scientists worldwide. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.