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Daniel J. Lovell, MD, MPH: JIA Treatment and Management Guidelines

Daniel J. Lovell, MD, MPH, explains the recent ACR guidelines updates regarding the treatment and management of juvenile idiopathic arthritis and the clinical significance of the changes.

Rheumatology Network interviewed Daniel J. Lovell, MD, MPH, to discuss the recent ACR guidelines updates regarding the treatment and management of juvenile idiopathic arthritis (JIA) and the clinical significance of the changes. Lovell is Professor of Pediatrics in the Division of Rheumatology at Cincinnati Children’s Hospital.

To continue to stay up to date on the latest treatment of JIA, the American College of Rheumatology (ACR) recently updated their guidelines for the first time since 2013.

Lovell highlights 2 important changes in the recent guideline changes involving systemic JIA (sJIA) and temporomandibular arthritis (TMJ). He explains that there are additional treatment options available for sJIA and rheumatologists have changed their treatment approach regarding initiation of interleukin 1 (IL-1) or IL-6) biologics for sJIA as a part of initial therapy even before a patient fully satisfies the International League of Associations for Rheumatology (ILAR) criteria.

The other recommendation is regarding the evaluation and treatment of temporomandibular joint as a unique joint, which behaves differently than other joints and, as Lovell explains, can be clinically silent.

“The level of scrutiny for TMJ has to be higher than for other joints, which are easier to examine and more likely to be symptomatic,” Lovell states. “Because of the frequency by which TMJ joints develop damage, and the long-term consequences for the patient, these treatment guidelines endorse a much more aggressive treatment approach for TMJ disease than you might for a JIA patient who only had 2 joints involved, for example.”

There are more reservations about repeat steroid injections into the TMJ joint because the risk of damage to the bone and cartilage from steroid injections are higher in this joint when compared with others.

“Overall, the treatment guidelines, as it related to treatment of disease calls for a much quicker and more aggressive introduction of treatments to achieve inactive disease,” Lovell concluded. “At the same time, the role of systemic steroids has become more restricted for non-systemic forms of JIA. The use of steroids as monotherapy or prolonged therapy is strongly discouraged.”

While this group of guidelines follows other guidelines in discouraging the use of chronic steroids for arthritis only, it is more strongly worded here. The use of NSAIDs as monotherapy is also downgraded in this set of recommendations.

Watch the interview below: