2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis
2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis
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DOI：
10.1002/acr.23870
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发表时间：
2019-06-01
影响因子：
4.7
通讯作者：
Reston, James
中科院分区：
文献类型：
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作者：
Ringold, Sarah;Angeles-Han, Sheila T.;Reston, James
ObjectiveDevelopmentTreatmentRecommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis，sacroiliitis，or enthesitis.MethodsThe Patient/Population，Intervention，Comparison，and Outcomes（皮科）questions were developed and refined by members of the guidelines development teams.进行了一项系统性综述，以汇编与这些疾病治疗相关的获益和危害的证据。GRADE（建议评估、发展和评价分级）方法用于评价证据质量。在投票小组中进行了小组共识过程，以产生最终建议并对其实力进行评级。家长和患者面板使用了类似的共识的方法，以提供患者/护理人员的偏好的关键questions.ResultsThirty-nine建议（8强和31有条件）。90%的建议的支持证据质量非常低或很低。推荐使用非甾体类抗风湿药、改善病情的抗风湿药、生物制剂、关节内和口服糖皮质激素。还提供了使用物理和职业治疗的建议。多关节炎的具体建议涉及一般药物使用，初始和后续治疗以及连续治疗。建议良好的疾病控制，治疗升级，以实现低疾病活动。骶髂关节炎和附着点炎的建议主要解决初始治疗和后续therapy.ConclusionThis指南提供了指导，为临床医生，护理人员和患者作出治疗决定。临床医生、护理人员和患者应使用共同的决策过程，考虑患者的价值观、偏好和合并症。这些建议不应用于限制或拒绝获得治疗。
ObjectiveTo develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis.MethodsThe 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.ResultsThirty-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. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies.ConclusionThis guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.