Juvenile Arthritis Guidelines Focus on Multiple Medications

Clinical guidelines for the management of juvenile idiopathic arthritis (JIA) recently released by the American College of Rheumatology (ACR) focus on the initiation and safety monitoring of treatment with multiple medications. Created as a reference for health care professionals and the first guidelines endorsed by the ACR, they are designed to provide evidence- and consensus-based guidance that reflects the current state of the field and is useful to clinicians of all levels of experience in the treatment of patients with JIA.

The medications featured in the guidelines include the following:

•NSAIDs (eg, ibuprofen and naproxen).

•Intra-articular corticosteroids.

•Nonbiologic disease-modifying antirheumatic drugs (DMARDs) (eg, methotrexate [MTX]).

•Biologic DMARDs (eg, abatacept; anakinra; and tumor necrosis factor α [TNF-α] inhibitors, such as etanercept, adalimumab, and infliximab).

•Systemic corticosteroids (prednisone).

Highlights of the recommendations include the following:

•Begin treatment with TNF-α inhibitors in children who have a history of arthritis in 4 or fewer joints and have significant active arthritis in spite of having received treatment with MTX.

•Begin treatment with TNF-α inhibitors in children who have a history of arthritis in 5 or more joints and have any active arthritis after an adequate trial of MTX.

•Begin treatment with anakinra in children who have systemic arthritis and active fever and whose treatment requires a second medication in addition to systemic corticosteroids.

For more information on these and other guidelines, visit the ACR Web site at http://www.rheumatology.org. Or, contact the organization at ACR, 2200 Lake Boulevard NE, Atlanta, GA 30319-5312; telephone: (404) 633-3777; fax: 633-1870.