Clinica Pediatrica e Reumatologia, Università degli Studi di Genova and Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina, Genoa, Italy.
Department of Pediatrics, Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany.
Ann Rheum Dis. 2018 Jun;77(6):819-828. doi: 10.1136/annrheumdis-2018-213030. Epub 2018 Apr 11.
Recent therapeutic advances in juvenile idiopathic arthritis (JIA) have made remission an achievable goal for most patients. Reaching this target leads to improved outcomes. The objective was to develop recommendations for treating JIA to target. A Steering Committee formulated a set of recommendations based on evidence derived from a systematic literature review. These were subsequently discussed, amended and voted on by an international Task Force of 30 paediatric rheumatologists in a consensus-based, Delphi-like procedure. Although the literature review did not reveal trials that compared a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated development of recommendations. The group agreed on six overarching principles and eight recommendations. The main treatment target, which should be based on a shared decision with parents/patients, was defined as remission, with the alternative target of low disease activity. The frequency and timeline of follow-up evaluations to ensure achievement and maintenance of the target depend on JIA category and level of disease activity. Additional recommendations emphasise the importance of ensuring adequate growth and development and avoiding long-term systemic glucocorticoid administration to maintain the target. All items were agreed on by more than 80% of the members of the Task Force. A research agenda was formulated. The Task Force developed recommendations for treating JIA to target, being aware that the evidence is not strong and needs to be expanded by future research. These recommendations can inform various stakeholders about strategies to reach optimal outcomes for JIA.
最近在幼年特发性关节炎（JIA）的治疗方面取得了进展，使大多数患者能够实现缓解的目标。达到这一目标可以改善治疗效果。目的是制定针对 JIA 的治疗建议，以实现目标。指导委员会根据系统文献综述中得出的证据制定了一套建议。随后，由 30 名儿科风湿病学家组成的国际工作组以基于共识的德尔菲式程序进行了讨论、修改和投票。尽管文献综述没有发现比较靶向治疗与另一种治疗策略或无治疗策略的试验，但它为优化治疗方法提供了间接证据，从而促进了建议的制定。该小组就六项总体原则和八项建议达成一致。主要的治疗目标应该基于与父母/患者的共同决策，定义为缓解，替代目标为低疾病活动度。为了确保达到和维持目标，需要根据 JIA 类别和疾病活动度确定随访评估的频率和时间安排。其他建议强调了确保充分生长发育和避免长期全身糖皮质激素治疗以维持目标的重要性。工作组的所有成员都对超过 80%的项目表示同意。制定了研究议程。工作组制定了针对 JIA 的治疗建议，以实现目标，同时意识到证据还不够强，需要通过未来的研究来扩展。这些建议可以让不同的利益相关者了解实现 JIA 最佳治疗效果的策略。
