TY - JOUR
T1 - Treating juvenile idiopathic arthritis to target
T2 - Recommendations of an international task force
AU - Ravelli, Angelo
AU - Consolaro, Alessandro
AU - Horneff, Gerd
AU - Laxer, Ronald M.
AU - Lovell, Daniel J.
AU - Wulffraat, Nico M.
AU - Akikusa, Jonathan D.
AU - Al-Mayouf, Sulaiman M.
AU - Antón, Jordi
AU - Avcin, Tadej
AU - Berard, Roberta A.
AU - Beresford, Michael W.
AU - Burgos-Vargas, Ruben
AU - Cimaz, Rolando
AU - De Benedetti, Fabrizio
AU - Demirkaya, Erkan
AU - Foell, Dirk
AU - Itoh, Yasuhiko
AU - Lahdenne, Pekka
AU - Morgan, Esi M.
AU - Quartier, Pierre
AU - Ruperto, Nicolino
AU - Russo, Ricardo
AU - Saad-Magalhães, Claudia
AU - Sawhney, Sujata
AU - Scott, Christiaan
AU - Shenoi, Susan
AU - Swart, Joost F.
AU - Uziel, Yosef
AU - Vastert, Sebastiaan J.
AU - Smolen, Josef S.
N1 - Publisher Copyright:
© 2018 Article author(s). All rights reserved.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Recent therapeutic advances in juvenile idiopathic arthritis (JIA) have made remission an achievable goal for most patients. Reaching this target leads to improved outcomes. The objective was to develop recommendations for treating JIA to target. A Steering Committee formulated a set of recommendations based on evidence derived from a systematic literature review. These were subsequently discussed, amended and voted on by an international Task Force of 30 paediatric rheumatologists in a consensus-based, Delphi-like procedure. Although the literature review did not reveal trials that compared a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated development of recommendations. The group agreed on six overarching principles and eight recommendations. The main treatment target, which should be based on a shared decision with parents/patients, was defined as remission, with the alternative target of low disease activity. The frequency and timeline of follow-up evaluations to ensure achievement and maintenance of the target depend on JIA category and level of disease activity. Additional recommendations emphasise the importance of ensuring adequate growth and development and avoiding long-term systemic glucocorticoid administration to maintain the target. All items were agreed on by more than 80% of the members of the Task Force. A research agenda was formulated. The Task Force developed recommendations for treating JIA to target, being aware that the evidence is not strong and needs to be expanded by future research. These recommendations can inform various stakeholders about strategies to reach optimal outcomes for JIA.
AB - Recent therapeutic advances in juvenile idiopathic arthritis (JIA) have made remission an achievable goal for most patients. Reaching this target leads to improved outcomes. The objective was to develop recommendations for treating JIA to target. A Steering Committee formulated a set of recommendations based on evidence derived from a systematic literature review. These were subsequently discussed, amended and voted on by an international Task Force of 30 paediatric rheumatologists in a consensus-based, Delphi-like procedure. Although the literature review did not reveal trials that compared a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated development of recommendations. The group agreed on six overarching principles and eight recommendations. The main treatment target, which should be based on a shared decision with parents/patients, was defined as remission, with the alternative target of low disease activity. The frequency and timeline of follow-up evaluations to ensure achievement and maintenance of the target depend on JIA category and level of disease activity. Additional recommendations emphasise the importance of ensuring adequate growth and development and avoiding long-term systemic glucocorticoid administration to maintain the target. All items were agreed on by more than 80% of the members of the Task Force. A research agenda was formulated. The Task Force developed recommendations for treating JIA to target, being aware that the evidence is not strong and needs to be expanded by future research. These recommendations can inform various stakeholders about strategies to reach optimal outcomes for JIA.
KW - juvenile idiopathic arthritis
KW - outcomes research
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=85047272617&partnerID=8YFLogxK
U2 - 10.1136/annrheumdis-2018-213030
DO - 10.1136/annrheumdis-2018-213030
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C2 - 29643108
AN - SCOPUS:85047272617
SN - 0003-4967
VL - 77
SP - 819
EP - 828
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 6
ER -