NEW YORK (Reuters Health)—An international task force says patients with juvenile idiopathic arthritis (JIA) should be treated to a target of clinical remission, among other new recommendations.
“The Task Force is convinced that transferring (the recommendations) into clinical practice will significantly improve the outcomes in patients with JIA,” Dr. Angelo Ravelli of the Istituto G. Gaslini in Genoa, Italy, and colleagues write in Annals of the Rheumatic Diseases, online April 11.
Disease-modifying antirheumatic drugs (DMARDs) have made remission possible for most JIA patients, Dr. Ravelli and his team note. Treating to target is now recommended for rheumatoid arthritis (RA) and several other rheumatic diseases, they add, but “the concept of targeted therapy has not yet been routinely implemented in pediatric rheumatology clinical care.”
While no studies have specifically tested a treat-to-target approach to JIA against the standard of care, the authors found, studies of early, aggressive treatment have shown benefits, offering indirect evidence for the approach. They offer six overarching principles and eight recommendations on treating JIA patients to target, including the following:
– Parents/patients and their pediatric rheumatology team must agree on treatment targets and therapeutic strategy.
– JIA is heterogeneous and treatment must be differentiated based on disease phenotype.
– Goals of treatment are to control signs and symptoms, prevent structural damage, avoid comorbidities and drug toxicities, and focus on function, growth and development, quality of life and social participation. Self-management is a key aim of treatment.
– Inflammation must be reduced to achieve treatment goals.
– Long-term systemic glucocorticoid use should be avoided.
– Treatment to target including regular disease-activity assessment and adjustment of therapy as needed is essential to reaching treatment goals.
– Clinical remission should be the target of treatment, while minimal disease activity can be an alternative, for example in patients with long-standing illness.
– Disease activity should be assessed and documented regularly with a validated composite instrument, at a frequency based on JIA category, disease activity level and extra-articular manifestations.
– All patients should have at least 50% improvement in disease activity within three months, and reach the target within six months. Fever should be resolved within a week in patients with JIA and active systemic manifestations.
– Treatment should be adjusted until the targeted is reached, and the target should be maintained with ongoing monitoring.
Dr. Ravelli was not available for an interview by press time.
- Ravelli A, Consolaro A, Horneff G, et al. Treating juvenile idiopathic arthritis to target: recommendations of an international task force. Annals of Rheumatic Diseases. 2018 Apr 11. [Epub ahead of print].