Consensus Treatment Plan Proposed for New-Onset JIA

July 8, 2014

Three proposed standardized treatment plans may also aid research into managing newly-diagnosed polyarticular juvenile idiopathic arthritis.

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 & Research (2014) 66:1063–1072. Article first published online: 26 Jun 2014. doi: 10.1002/acr.22259.

Noting a lack of data on the safety and efficacy of medications for the initial treatment of new-onset polyarticular juvenile idiopathic arthritis (JIA), the Childhood Arthritis and Rheumatology Research Alliance (CARRA) proposes three treatment plans that reflect strategies currently in use by clinicians.

The coalition of pediatric rheumatologists says that use of standardized consensus treatment plans (CTP) should improve patient outcomes and help optimize disease management in the future.

The CTPs all call for scheduled assessments at 3, 6, and 12 months of treatment, and more often if needed. Each plan has a  different algorithms to specify starting medications for treatment naïve JIA patients, drug dosing and monitoring.

   Step-up plan begins with a nonbiologic disease-modifying anti-rheumatic drug (DMARD) like methotrexate, with optional oral prednisone and cortisone injections, followed by a biologic DMARD if there is an inadequate response in 3 to 6 months. Treatment would be changed or adjusted at one year.

   Early treatment plan combines non-biologic and biologic drugs, such as tumor necrosis factor-alpha (TNF-α) blockers, with optional, tapered prednisone and intra-articular steroid (IAS) injections. Medications could be increased or changed at 3, 6, or 12 months, depending on patient response, discontinuing prednisone at 3 months,

   Biologics-only CTP also includes tapered oral prednisone and optional IAS injections. Non-biologics can be considered or the biologic changed if a patient is not much better and/or is unable to stop prednisone.

CARRA says that coupled with regular data collection these proposed plans will facilitate comparative effectiveness studies of medications and treatment strategies.