Article

Evidence and consensus based GKJR guidelines for the treatment of juvenile idiopathic arthritis

HELIOS Children's Hospital, Krefeld, Germany.
Clinical Immunology (Impact Factor: 3.99). 10/2011; 142(2):176-93. DOI: 10.1016/j.clim.2011.10.003
Source: PubMed

ABSTRACT Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and adolescents. Immunomodulatory drugs are used frequently in its treatment. Using the nominal group technique (NGT) and Delphi method, we created a multidisciplinary, evidence- and consensus-based treatment guideline for JIA based on a systematic literature analysis and three consensus conferences. Conferences were headed by a professional moderator and were attended by representatives who had been nominated by their scientific societies or organizations. 15 statements regarding drug therapy, symptomatic and surgical management were generated. It is recommended that initially JIA is treated with NSAID followed by local glucocorticoids and/or methotrexate if unresponsive. Complementing literature evidence with long-standing experience of caregivers allows creating guidelines that may potentially improve the quality of care for children and adolescents with JIA.

0 Followers
 · 
182 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic condition in childhood, with many children requiring immunomodulatory therapies for many years following diagnosis. A considerable proportion of children experience therapeutic inefficacy or substantial adverse effects, or both, but a lack of reliable clinical indicators and biomarkers to predict treatment response prevents optimization of existing therapies. The identification of valid candidate gene variants involved in the pathways of methotrexate and etanercept, the most commonly used medications in JIA, has seen little success to date. The limited success of these studies is possibly due to the presence of confounding variables in the study populations, the heterogeneity of outcome parameters used to determine treatment response and the small number of candidate gene variants analysed. The first genome-wide pharmacogenetic study in JIA has identified gene regions of particular biological interest, but these findings require validation. Moreover, epigenetic mechanisms as well as ontogeny processes might be additional factors influencing drug responses. Access to large, well-documented JIA cohorts and the rapid development of advanced genome analytics is ushering in a personalized approach to treatment. The discovery of new pharmacogenomic biomarkers and systems pathways can provide new drug targets and predictive tools for improved drug response and fewer adverse drug reactions in JIA.
    Nature Reviews Rheumatology 08/2014; 10(11). DOI:10.1038/nrrheum.2014.140 · 10.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Die juvenile idiopathische Arthritis (JIA) ist die häufigste chronisch-entzündliche Erkrankung im Kindes- und Jugendalter. In Deutschland liegt die Inzidenz bei etwa 4–7 pro 100.000 Kinder und Jugendliche unter 16 Jahren, die Zahl an Neukrankungen beträgt etwa 1000 pro Jahr. Bei der Diagnosestellung wird aktuell die ILAR-Klassifikation (ILAR: „International League of Associations for Rheumatology“) zugrunde gelegt. Demnach liegt eine JIA vor bei Arthritis eines oder mehrerer Gelenke, die für mindestens 6 Wochen anhält und vor dem 16. Geburtstag des Patienten beginnt. Andere Erkrankungen, die ähnliche Symptome verursachen können, müssen ausgeschlossen sein. Es werden 8 verschiedene Subgruppen der JIA unterschieden. Hieraus ergeben sich subgruppenspezifische Implikationen für mögliche Organbeteiligungen, Therapie und Prognose.Die vorliegende Handlungsempfehlung beruht auf der entsprechenden AWMF-Leitlinie (AWMF: Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaften ...
    Monatsschrift Kinderheilkunde 01/2012; 161(1):60-62. DOI:10.1007/s00112-012-2837-8 · 0.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite the enormous progress in the treatment of juvenile idiopathic arthritis (JIA), innovations based on true bench-to-bedside research, performed in JIA patients, are still scarce. This chapter describes novel developments in which clinical innovations go hand in hand with basic discoveries. For the purpose of this review, we will mainly focus on developments in severe forms of JIA, most notably systemic JIA and polyarticular JIA. However, also in less severe forms of JIA, such as oligoarticular JIA, better insight will help to improve diagnosis and treatment. Facilitating the transition from bench to bedside will prove crucial for addressing the major challenges in JIA management. If successful, it will set new standards for a safe, targeted and personalized therapeutic approach for children with JIA.
    Bailli&egrave re s Best Practice and Research in Clinical Rheumatology 04/2014; 28(2):229-246. DOI:10.1016/j.berh.2014.05.002 · 3.06 Impact Factor

Full-text (2 Sources)

Download
37 Downloads
Available from
May 20, 2014