This protocol addresses children with juvenile idiopathic arthritis (JIA) and polyarthritis — five or more joints ever involved — who do not have systemic arthritis or sacroiliitis. This population may span different JIA categories and is defined specifically by its polyarticular joint burden alongside the exclusion of systemic and sacroiliac disease.
Recommendations for this population prioritise initiating disease-modifying antirheumatic drug (DMARD) therapy as the foundational strategy, rather than anti-inflammatory therapy alone — with specific agent selection and adjunctive options detailed in the full protocol.
The primary clinical target is achieving low disease activity, defined as a cJADAS-10 score of ≤2.5. Response is evaluated over an adequate trial period; if insufficient improvement is observed early, adjustment or escalation of therapy may be appropriate.
This group includes children with JIA and polyarthritis (≥5 joints ever involved) and may include children from different ILAR JIA categories but excludes children with systemic arthritis or sacroiliitis.
Initial therapy with a DMARD is strongly recommended over NSAID monotherapy.
Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. Low disease activity was further defined as a cJADAS-10 of ≤2.5 and ≥1 joint with active disease to ensure that active arthritis was also present.
DOI: 10.1002/acr.23870
View source ↗