Juvenile rheumatoid arthritis guidelines. Resurse - Societatea Româna de Reumatologie Pediatrica (SRRP)
Juvenile Idiopathic Arthritis
Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidelines and recommendations developed and endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice.
ACR recommendations are not intended to dictate payment or insurance decisions. These recommendations cannot adequately convey all uncertainties and nuances of patient care.
The American College of Rheumatology is an independent, professional, medical and scientific society that does not guarantee, warrant, or endorse any commercial product or service. Objective To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis JIA. Methods Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline.
This was followed by a systematic literature review and rating of the available evidence according to the GRADE Grading of Recommendations Assessment, Development and Evaluation methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong.
Results Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, juvenile rheumatoid arthritis guidelines intervals should be based on ocular examination findings and treatment regimen.
Ophthalmic monitoring recommendations were strong primarily because of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation.
Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss.