Table 2

Recommendations to treat juvenile idiopathic arthritis (JIA) to target

Percentage of positive
votes at consensus
conference
Level of evidenceStrength of recommendationMean±SD level of agreement
Overarching principles
A. The treatment targets and the therapeutic strategy should be based on shared decisions between the parents/patient and the paediatric rheumatology healthcare team.909.8±0.5
B. JIA is a heterogeneous group of diseases that requires distinct treatment approaches.10010
C. The goals of treating patients with JIA are to control signs and symptoms; to prevent structural damage; to avoid comorbid conditions and drug toxicities; and to optimise function, growth and development, quality of life, and social participation.10010
D. Abrogation of inflammation is essential to achieve these goals.1009.8±0.5
E. Long-term use of systemic glucocorticoids to maintain the target should be avoided.1009.8±0.5
F. Treatment to target by regularly assessing disease activity and adapting therapy accordingly is important to achieve these goals.10010
Recommendations
1. The primary target for treatment of patients with JIA is clinical remission, which means the absence of signs and symptoms of inflammatory disease activity, including extra-articular manifestations.852bC9.7±0.5
2. Minimal (or low) disease activity may be an alternative target, particularly in patients with long-standing disease.972cB9.7±0.6
3. Setting the target, selecting the tools and the therapeutic decisions should be based on individual patients’ characteristics and agreed on with the parents/patient.1005D9.7±0.6
4. Disease activity should be assessed and documented regularly using a validated composite instrument.1002cC9.8±0.5
5. The frequency of assessments depends on the category of JIA, level of disease activity and presence of extra-articular manifestations. This may require weekly assessments, such as in systemic JIA with active systemic manifestations; monthly to every 3 months evaluations for patients who have high/moderate disease activity; and less frequent assessments, in states of persistent clinical remission.935C9.6±0.7
6. In all patients, at least a 50% improvement in disease activity should be reached within 3 months and the target within 6 months. In patients with systemic JIA with active systemic manifestations, resolution of fever should be attained within 1 week.932bB9.2±0.9
7. Treatment should be adjusted until the target is achieved.1002bC9.7±1.0
8. Once the treatment target has been achieved, it should be sustained. Ongoing monitoring should occur to ensure maintenance of the target.1002bC9.9±0.3