Treatment of polyarticular juvenile idiopathic arthritis in Latin America: recommendations from the Pan-American League of Associations for Rheumatology

IF 15.5 1区医学 Q1 PEDIATRICS

Lancet Child & Adolescent Health Pub Date : 2025-06-10 DOI:10.1016/S2352-4642(25)00122-1

Raúl Gutiérrez-Suárez MD MSc , Prof Simone Appenzeller PhD , Prof Clovis Artur Silva MD , Adriana Rodrigues Fonseca PhD , Zoilo Morel MD , Ruth Eraso MD , Lorena Franco MD , Rubén J Cuttica MD , Manuel Alberto Ferrándiz Zavaler MD , Karen Viviana Jiménez Cruz MD , María L Barzola MD , Eduardo Talesnik MD , Enrique Faugier Fuentes MD , Amparo Ibañez Estrella MD , Rosario M Jurado MD , Ivonne L Arroyo Rivera MD , Pilar Guarnizo Zuccardi MD , Beatriz H León Nogués MD , Carmen Rodriguez Tineo MD , Cristina N Herrera MD , Graciela Espada MD

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Abstract

To develop evidence-based treatment guidelines for non-systemic polyarticular-juvenile idiopathic arthritis (poly-JIA) in Latin America, endorsed by the Pan-American League of Associations for Rheumatology (PANLAR), a panel of paediatric rheumatologists from Latin America formulated clinically relevant questions regarding polyarthritis treatment, using the Population, Intervention, Comparator, and Outcome (PICO) format. Following the Grading of Recommendations Assessment, Development, and Evaluation methodology, a team of methodologists conducted a systematic literature review, extracted and summarised intervention effect estimates, and assessed the quality of evidence. The panel of paediatric rheumatologists voted on each PICO question and formulated recommendations, requiring a consensus of at least 70% amongst the voting members. Eight recommendations and one expert opinion statement were developed. For newly diagnosed poly-JIA or those with minimal disease activity, the use of non-steroidal anti-inflammatory drugs as adjuvant therapy, along with a non-biological disease-modifying antirheumatic drug (nbDMARD) is recommended. For children and young people achieving an inactive disease state, continuation of nbDMARD treatment for at least 12 months post-remission is advised. In cases of methotrexate intolerance, contraindications, limited availability, or non-response, leflunomide could be used as an alternative. For children and young people with high disease activity or poor prognostic factors, the addition of a biological disease-modifying antirheumatic drug (bDMARD) is recommended. Triple therapy with methotrexate, sulfasalazine, and hydroxychloroquine can be considered when bDMARDs are not available. Low-dose, short-term corticosteroid use is also recommended. The first PANLAR poly-JIA treatment guidelines offer evidence-based recommendations to support health-care providers in the management of poly-JIA in Latin America.

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拉丁美洲多关节幼年特发性关节炎的治疗：来自泛美风湿病协会联盟的建议

为了制定拉丁美洲非系统性多关节青少年特发性关节炎（poly-JIA）的循证治疗指南，由泛美风湿病协会联盟（PANLAR）批准，拉丁美洲的儿科风湿病学家小组使用人口、干预、比较物和结果（PICO）格式制定了关于多关节炎治疗的临床相关问题。根据分级推荐评估、发展和评价方法，一组方法学家进行了系统的文献综述，提取和总结了干预效果估计，并评估了证据的质量。儿科风湿病专家小组对每个PICO问题进行投票并制定建议，要求投票成员中至少70%的人达成共识。拟定了八项建议和一项专家意见声明。对于新诊断的poly-JIA或疾病活动性最小的患者，建议使用非甾体抗炎药作为辅助治疗，同时使用非生物疾病改善抗风湿药物（nbDMARD）。对于达到非活动性疾病状态的儿童和年轻人，建议在缓解后继续使用nbDMARD治疗至少12个月。在甲氨蝶呤不耐受、禁忌症、可用性有限或无反应的情况下，来氟米特可作为替代。对于疾病活动性高或预后因素差的儿童和年轻人，建议添加生物疾病改善抗风湿药物（bDMARD）。当没有bdmard时，可以考虑采用甲氨蝶呤、磺胺氮嗪和羟氯喹三联疗法。也建议使用低剂量、短期的皮质类固醇。首个PANLAR多jia治疗指南提供了基于证据的建议，以支持拉丁美洲卫生保健提供者管理多jia。

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来源期刊

Lancet Child & Adolescent Health Psychology-Developmental and Educational Psychology

CiteScore

40.90

自引率

0.80%

发文量

381

期刊介绍： The Lancet Child & Adolescent Health, an independent journal with a global perspective and strong clinical focus, presents influential original research, authoritative reviews, and insightful opinion pieces to promote the health of children from fetal development through young adulthood. This journal invite submissions that will directly impact clinical practice or child health across the disciplines of general paediatrics, adolescent medicine, or child development, and across all paediatric subspecialties including (but not limited to) allergy and immunology, cardiology, critical care, endocrinology, fetal and neonatal medicine, gastroenterology, haematology, hepatology and nutrition, infectious diseases, neurology, oncology, psychiatry, respiratory medicine, and surgery. Content includes articles, reviews, viewpoints, clinical pictures, comments, and correspondence, along with series and commissions aimed at driving positive change in clinical practice and health policy in child and adolescent health.