Gutiérrez-Suárez Raúl, Appenzeller Simone, Silva Clovis Artur, Fonseca Adriana Rodrigues, Morel Zoilo, Eraso Ruth, Franco Lorena, Cuttica Rubén J, Zavaler Manuel Alberto Ferrándiz, Cruz Karen Viviana Jiménez, Barzola María L, Talesnik Eduardo, Fuentes Enrique Faugier, Estrella Amparo Ibañez, Jurado Rosario M, Rivera Ivonne L Arroyo, Zuccardi Pilar Guarnizo, Nogués Beatriz H León, Tineo Carmen Rodriguez, Herrera Cristina N, Caffa Juan A Cameto, Ringer Ariana, Stieben Luis A Ramirez, Brun Lucas R, Zúcaro Nicolás M Marín, Fernández-Ávila Daniel G, Brance María Lorena, Espada Graciela
Hospital para el niño, Instituto Materno Infantil del Estado de México, Toluca, México; Hospital Shriners Para Niños, México City, México.
University of Campinas, Sao Paulo, Brazil.
Lancet Child Adolesc Health. 2025 Jul;9(7):508-518. doi: 10.1016/S2352-4642(25)00122-1.
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.
为制定拉丁美洲非系统性多关节型幼年特发性关节炎（多关节型幼年特发性关节炎）的循证治疗指南，该指南获泛美风湿病协会联盟（PANLAR）认可，来自拉丁美洲的一组儿科风湿病学家采用人群、干预措施、对照和结局（PICO）格式，提出了有关多关节炎治疗的临床相关问题。按照推荐分级评估、制定和评价方法，一组方法学家进行了系统的文献综述，提取并总结了干预效果估计值，并评估了证据质量。儿科风湿病学家小组就每个PICO问题进行投票并制定建议，要求投票成员中至少70%达成共识。制定了八项建议和一项专家意见声明。对于新诊断的多关节型幼年特发性关节炎患者或疾病活动度最低的患者，建议使用非甾体抗炎药作为辅助治疗，并联合使用一种非生物改善病情抗风湿药（nbDMARD）。对于实现疾病非活动状态的儿童和青少年，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、有禁忌证、可用性有限或无反应的情况下，可使用来氟米特作为替代药物。对于疾病活动度高或预后因素差的儿童和青少年，建议加用一种生物改善病情抗风湿药（bDMARD）。在无法使用bDMARD时，可考虑甲氨蝶呤、柳氮磺胺吡啶和羟氯喹三联疗法。也建议低剂量、短期使用皮质类固醇。首份PANLAR多关节型幼年特发性关节炎治疗指南提供了循证建议，以支持拉丁美洲的医疗保健提供者管理多关节型幼年特发性关节炎。
