For those children with a history of arthritis of five or more joints, initiation of TNF-α inhibitors is recommended for essentially all patients with any active arthritis following an adequate trial of methotrexate, Dr. Beukelman says.
Another notable recommendation is that anakinra is recommended for children with systemic arthritis who require a steroid-sparing agent because of active fever, he says.
Recommendations, Not Guidelines
The authors stress that the 2011 recommendations are not meant to be guidelines, an indication of their “nonprescriptive nature.” They are also not intended to replace patient assessment and clinical decision making, particularly for physicians who have experience treating JIA.
According to the authors, the knowledge about the therapy of JIA is expected to advance in coming years, and they suggest that the recommendations be updated in about three years. Several areas of research are lacking—including comparative long-term studies of the benefits and risks of early initiation of biologic therapies, as well as the development and implementation of continuous disease activity scores in clinical practice—and further studies are needed to improve knowledge and management of JIA.
Kathy Holliman is a medical journalist based in New Jersey.
References
- Beukelman T, Patkar NM, Saag KG, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: Initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Rheum. 2011;63:465-482.
- Beukelman T, Haynes K, Curtis JR, et al. Rates of malignancy associated with juvenile idiopathic arthritis and its treatment: An observational study of national U.S. Medicaid administrative claims data. #2084. Presented at ACR/ARHP Scientific Meeting. Nov. 7–11, 2010. Atlanta.
