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General treatment aspects

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Handbook of Juvenile Idiopathic Arthritis

Abstract

The management of juvenile idiopathic arthritis (JIA) is based on a combination of pharmacologic interventions, physical and occupational therapy, and psychosocial support [1, 2]. The goal of treatment should be to induce disease remission, control pain, facilitate normal nutrition and growth, preserve the physical and psychological well-being, and prevent long-term damage related to the disease or its therapy. Although we still do not possess medications that are able to cure the disease, prognosis has greatly improved in recent years owing to major progress in therapy. These advances have increased the expectation for disease control [3–6]. It is increasingly recognized that there can be a window of opportunity to most effectively treat JIA, and evidence is accumulating to support the benefit of early aggressive therapy [7–11].

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References

  1. Petty RE, Cassidy JT. Chronic arthritis in childhood. In: Cassidy JT, Petty RE, Laxer RM, Lindsley CB, eds. Textbook of Pediatric Rheumatology. 6th edn. Philadelphia, PA: Elsevier Saunders; 2011;211-235.

    Google Scholar 

  2. Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369:767-778.

    Google Scholar 

  3. Martini A, Lovell DJ. Juvenile idiopathic arthritis: state of the art and future perspectives. Ann Rheum Dis. 2010;69:1260-1263.

    Google Scholar 

  4. Ruperto N, Giannini EH, Pistorio A, Brunner HI, Martini A, Lovell DJ. Is it time to move to active comparator trials in juvenile idiopathic arthritis? A review of current study designs. Arthritis Rheum. 2010;62:3131-3139.

    Google Scholar 

  5. Lovell DJ, Ruperto N, Giannini EH, Martini A. Advances from clinical trials in juvenile idiopathic arthritis. Nat Rev Rheumatol. 2013;9:557-563.

    Google Scholar 

  6. Consolaro A, Ravelli A. It is worth including assessment of disease activity state in juvenile arthritis clinical trials. Arthritis Care Res (Hoboken). 2013;65:1207-1210.

    Google Scholar 

  7. Wallace CA, Giannini EH, Spalding SJ, et al. Trial of early aggressive therapy in polyarticular juvenile idiopathic arthritis. Arthritis Rheum. 2012;64:2012-2021.

    Google Scholar 

  8. Nigrovic PA, Mannion M, Prince FH, et al. Anakinra as first-line disease-modifying therapy in systemic juvenile idiopathic arthritis: report of forty-six patients from an international multicenter series. Arthritis Rheum. 2011;63:545-555.

    Google Scholar 

  9. Vastert SJ, de Jager W, Noordman BJ, et al. Effectiveness of first-line treatment with recombinant interleukin-1 receptor antagonist in steroid-naive patients with new-onset systemic juvenile idiopathic arthritis: results of a prospective cohort study. Arthritis Rheum. 2014;66:1034-1043.

    Google Scholar 

  10. Martini A. Systemic juvenile idiopathic arthritis. Autoimmun Rev. 2012;12:56-59.

    Google Scholar 

  11. Nigrovic PA. Review: is there a window of opportunity for treatment of systemic juvenile idiopathic arthritis? Arthritis Rheum. 2014;66:1405-1413.

    Google Scholar 

  12. Giannini EH, Ruperto N, Ravelli A, Lovell DJ, Felson DT, Martini A. Preliminary definition of improvement in juvenile arthritis. Arthritis Rheum. 1997;40:1202-1209.

    Google Scholar 

  13. Ruperto N, Murray KJ, Gerloni V, et al. A randomized trial of parenteral methotrexate comparing an intermediate dose with a higher dose in children with juvenile idiopathic arthritis who failed to respond to standard doses of methotrexate. Arthritis Rheum. 2004;50:2191-2201.

    Google Scholar 

  14. Lovell DJ, Giannini EH, Reiff A, et al. Etanercept in children with polyarticular juvenile rheumatoid arthritis. Pediatric Rheumatology Collaborative Study Group. N Engl J Med. 2000;342:763-769.

    Google Scholar 

  15. Lovell DJ, Ruperto N, Goodman S, et al. Adalimumab with or without methotrexate in juvenile rheumatoid arthritis. N Engl J Med. 2008;359:810-820.

    Google Scholar 

  16. Ruperto N, Lovell DJ, Quartier P, et al. Abatacept in children with juvenile idiopathic arthritis: a randomised, double-blind, placebo-controlled withdrawal trial. Lancet. 2008;372:383-391.

    Google Scholar 

  17. Yokota S, Imagawa T, Mori M, et al. Efficacy and safety of tocilizumab in patients with systemic-onset juvenile idiopathic arthritis: a randomised, double-blind, placebocontrolled, withdrawal phase III trial. Lancet. 2008;371:998-1006.

    Google Scholar 

  18. De Benedetti F, Brunner HI, Ruperto N, et al. Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis. N Engl J Med. 2012;367:2385-2395.

    Google Scholar 

  19. Ruperto N, Brunner HI, Quartier P, et al. Two randomized trials of canakinumab in systemic juvenile idiopathic arthritis. N Engl J Med. 2012;367:2396-2406.

    Google Scholar 

  20. Wallace CA, Ruperto N, Giannini E. Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. J Rheumatol. 2004;31:2290-2294.

    Google Scholar 

  21. Wallace CA, Huang B, Bandeira M, Ravelli A, Giannini EH. Patterns of clinical remission in select categories of juvenile idiopathic arthritis. Arthritis Rheum. 2005;52:3554-3562.

    Google Scholar 

  22. Ravelli A, Martini A. Remission in juvenile idiopathic arthritis. Clin Exp Rheumatol. 2006;24:S105-S110.

    Google Scholar 

  23. Magnani A, Pistorio A, Magni-Manzoni S, et al. Achievement of a state of inactive disease at least once in the first 5 years predicts better outcome of patients with polyarticular juvenile idiopathic arthritis. J Rheumatol. 2009;36:628-634.

    Google Scholar 

  24. Wallace CA, Giannini EH, Huang B, Itert L, Ruperto N. American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res (Hoboken ). 2011;63:929-936.

    Google Scholar 

  25. Wells G, Boers M, Shea B, et al. MCID/Low Disease Activity State Workshop: low disease activity state in rheumatoid arthritis. J Rheumatol. 2003;30:1110-1111.

    Google Scholar 

  26. Magni-Manzoni S, Ruperto N, Pistorio A, et al. Development and validation of a preliminary definition of minimal disease activity in patients with juvenile idiopathic arthritis. Arthritis Rheum. 2008;59:1120-1127.

    Google Scholar 

  27. Consolaro A, Ruperto N, Bazso A, et al. Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis Rheum. 2009;61:658-666.

    Google Scholar 

  28. Nordal EB, Zak M, Aalto K, et al. Validity and predictive ability of the juvenile arthritis disease activity score based on CRP versus ESR in a Nordic population-based setting. Ann Rheum Dis. 2012;71:1122-1127.

    Google Scholar 

  29. Consolaro A, Bracciolini G, Ruperto N, et al. Remission, minimal disease activity and acceptable symptom state in juvenile idiopathic arthritis: defining criteria based on the juvenile arthritis disease activity score. Arthritis Rheum. 2012;64:2366-2374.

    Google Scholar 

  30. Consolaro A, Ruperto N, Bracciolini G, et al. Defining criteria for high disease activity in juvenile idiopathic arthritis based on the juvenile arthritis disease activity score. Ann Rheum Dis. 2014;73:1380-1383.

    Google Scholar 

  31. McErlane F, Beresford MW, Baildam EM, et al. Validity of a three-variable Juvenile Arthritis Disease Activity Score in children with new-onset juvenile idiopathic arthritis. Ann Rheum Dis. 2013;72:1983-1988.

    Google Scholar 

  32. Consolaro A, Negro G, Chiara Gallo M, et al. Defining criteria for disease activity states in nonsystemic juvenile idiopathic arthritis based on a three-variable juvenile arthritis disease activity score. Arthritis Care Res (Hoboken). 2014;66:1703-1709.

    Google Scholar 

  33. Consolaro A, Negro G, Lanni S, Solari N, Martini A, Ravelli A. Toward a treat-to-target approach in the management of juvenile idiopathic arthritis. Clin Exp Rheumatol. 2012;30:S157-S162.

    Google Scholar 

  34. Grigor C, Capell H, Stirling A, McMahon AD, Lock P, Vallance R et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet. 2004;364:263-269.

    Google Scholar 

  35. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, van ZD, Kerstens PJ, Hazes JM et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): A randomized, controlled trial. Arthritis Rheum. 2008;58:S126-S135.

    Google Scholar 

  36. Horneff G, Becker I. Definition of improvement in juvenile idiopathic arthritis using the juvenile arthritis disease activity score. Rheumatology (Oxford). 2014;53:1229-1234.

    Google Scholar 

  37. Weiss PF, Colbert RA, Xiao R, et al. Development and retrospective validation of the juvenile spondyloarthritis disease activity index. Arthritis Care Res (Hoboken). 2014;66:1775-1782.

    Google Scholar 

  38. 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 Care Res (Hoboken). 2011;63:465-482.

    Google Scholar 

  39. Ringold S, Weiss PF, Beukelman T, et al. 2013 update of the 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: recommendations for the medical therapy of children with systemic juvenile idiopathic arthritis and tuberculosis screening among children receiving biologic medications. Arthritis Rheum. 2013;65:2499-2512.

    Google Scholar 

  40. Ringold S, Weiss PF, Colbert RA, et al. Childhood Arthritis and Rheumatology Research Alliance consensus treatment plans for new-onset polyarticular juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2014;66:1063-1072.

    Google Scholar 

  41. Dewitt EM, Kimura Y, Beukelman T, et al. Consensus treatment plans for new-onset systemic juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2012;64:1001-1010.

    Google Scholar 

  42. Kimura Y, DeWitt EM, Beukelman T, et al. Adding canakinumab to the Childhood Arthritis and Rheumatology Research Alliance consensus treatment plans for systemic juvenile idiopathic arthritis: Comment on the article by DeWitt et al. Arthritis Care Res (Hoboken). 2014;66:1430-1431.

    Google Scholar 

  43. Dueckers G, Guellac N, Arbogast M, et al. Evidence and consensus based GKJR guidelines for the treatment of juvenile idiopathic arthritis. Clin Immunol. 2012;142:176–193.

    Google Scholar 

  44. Davies K, Cleary G, Foster H, Hutchinson E, Baildam E. BSPAR Standards of Care for children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford). 2010;49:1406-1408.

    Google Scholar 

  45. Giancane G, Ter Haar NM, Wulffraat N, et al. Evidence-based recommendations for genetic diagnosis of familial Mediterranean fever. Ann Rheum Dis. 2015;74:635-641.

    Google Scholar 

  46. Filocamo G, Consolaro A, Schiappapietra B, et al. Introducing a new approach into clinical care of children with juvenile idiopathic arthritis: the juvenile arthritis multidimensional assessment report. J Rheumatol. 2011;38:938-953.

    Google Scholar 

  47. Hashkes PJ, Laxer RM. Medical treatment of juvenile idiopathic arthritis. JAMA. 2005;294:1671-1684.

    Google Scholar 

  48. Hayward K, Wallace CA. Recent developments in anti-rheumatic drugs in pediatrics: treatment of juvenile idiopathic arthritis. Arthritis Res Ther. 2009;11:216.

    Google Scholar 

  49. Ruperto N, Martini A. Current medical treatments for juvenile idiopathic arthritis. Front Pharmacol. 2011;2:60.

    Google Scholar 

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Authors and Affiliations

  1. Giannina Gaslini Institute, University of Genova, Genoa, Italy

    Angelo Ravelli

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  1. Angelo Ravelli
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Correspondence to Angelo Ravelli .

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Ravelli, A. (2016). General treatment aspects. In: Handbook of Juvenile Idiopathic Arthritis. Adis, Cham. https://doi.org/10.1007/978-3-319-08102-1_6

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  • DOI: https://doi.org/10.1007/978-3-319-08102-1_6

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  • Publisher Name: Adis, Cham

  • Print ISBN: 978-3-319-08101-4

  • Online ISBN: 978-3-319-08102-1

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