作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Interpretation on the 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis
-
摘要: 为改善幼年特发性关节炎(juvenile idiopathic arthritis, JIA)患儿预后, 继2019年发布的针对多关节型JIA、骶髂关节炎、附着点炎及JIA相关葡萄膜炎患儿的治疗指导后, 美国风湿病学会(American College of Rheumatology, ACR)于2022年3月发布了新的JIA治疗指南, 内容包括药物治疗和非药物治疗两部分, 其中药物治疗部分主要针对少关节型和全身型JIA(systemic JIA, sJIA)及颞颌关节炎。本文将对指南主要内容进行解读, 以供临床医生借鉴和参考。Abstract: In order to improve the prognosis of children with juvenile idiopathic arthritis (JIA), following the treatment guideline issued in 2019, the American College of Rheumatology (ACR) published new guidelines for the treatment of JIA in March 2022, including recommendations for both pharmacologic and nonpharmacologic therapies. The pharmacologic management focuses on treatment of oligoarthritis, temporomandibular joint arthritis, and systemic JIA. This article provides Chinese physicians with detailed interpretation of this guideline, for the purpose of better applying it in their clinical practice.
-
Key words:
- juvenile idiopathic arthritis /
- treatment /
- guideline /
- children
作者贡献：钟林庆负责查阅文献资料及撰写论文；宋红梅负责指导及修订论文。利益冲突：所有作者均声明不存在利益冲突 -
图 1 少关节型JIA治疗流程[1]
JIA：幼年特发性关节炎；GCs：糖皮质激素；NSAIDs：非甾体抗炎药；DMARDs：改善病情的抗风湿药物；MTX：甲氨蝶呤；LEF：来氟米特；SSZ：柳氮磺胺吡啶；HCQ：羟氯喹
-
[1] Onel KB, Horton DB, Lovell DJ, et al. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Syste-mic Juvenile Idiopathic Arthritis[J]. Arthritis Rheumatol, 2022, 74: 553-569. doi: 10.1002/art.42037 [2] Onel KB, Horton DB, Lovell DJ, et al. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging[J]. Arthritis Care Res (Hoboken), 2022, 74: 505-520. doi: 10.1002/acr.24839 [3] Ringold S, Angeles-Han ST, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis[J]. Arthritis Rheumatol, 2019, 71: 846-863. doi: 10.1002/art.40884 [4] Angeles-Han ST, Ringold S, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis[J]. Arthritis Rheumatol, 2019, 71: 864-877. doi: 10.1002/art.40885 [5] Zulian F, Martini G, Gobber D, et al. Comparison of intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligoarticular juvenile idiopathic arthritis[J]. Rheumatology (Oxford), 2003, 42: 1254-1259. doi: 10.1093/rheumatology/keg358 [6] Zulian F, Martini G, Gobber D, et al. Triamcinolone acetonide and hexacetonide intra-articular treatment of symmetrical joints in juvenile idiopathic arthritis: a double-blind trial[J]. Rheumatology (Oxford), 2004, 43: 1288-1291. doi: 10.1093/rheumatology/keh313 [7] Eberhard BA, Sison MC, Gottlieb BS, et al. Comparison of the intraarticular effectiveness of triamcinolone hexaceto-nide and triamcinolone acetonide in treatment of juvenile rheumatoid arthritis[J]. J Rheumatol, 2004, 31: 2507-2512. [8] Wallace CA, Huang B, Bandeira M, et al. Patterns of clinical remission in select categories of juvenile idiopathic arthritis[J]. Arthritis Rheum, 2005, 52: 3554-3562. doi: 10.1002/art.21389 [9] Wallace CA, Giannini EH, Huang B, et al. American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis[J]. Arthritis Care Res (Hoboken), 2011, 63: 929-936. doi: 10.1002/acr.20497 [10] Consolaro A, Ruperto N, Bazso A, et al. Development and validation of a composite disease activity score for juvenile idiopathic arthritis[J]. Arthritis Rheum, 2009, 61: 658-666. doi: 10.1002/art.24516 [11] McErlane F, Beresford MW, Baildam EM, et al. Validity of a three-variable Juvenile Arthritis Disease Activity Score in children with new-onset juvenile idiopathic arthritis[J]. Ann Rheum Dis, 2013, 72: 1983-1988. doi: 10.1136/annrheumdis-2012-202031 [12] Tibaldi J, Pistorio A, Aldera E, et al. Development and initial validation of a composite disease activity score for systemic juvenile idiopathic arthritis[J]. Rheumatology (Oxford), 2020, 59: 3505-3514. doi: 10.1093/rheumatology/keaa240 [13] Aikawa NE, Trudes G, Campos LM, et al. Immunogeni-city and safety of two doses of a non-adjuvanted influenza A H1N1/2009 vaccine in young autoimmune rheumatic diseases patients[J]. Lupus, 2013, 22: 1394-1398. doi: 10.1177/0961203313505926 [14] Toplak N, Subelj V, Kveder T, et al. Safety and efficacy of influenza vaccination in a prospective longitudinal study of 31 children with juvenile idiopathic arthritis[J]. Clin Exp Rheumatol, 2012, 30: 436-444. [15] Heijstek MW, Scherpenisse M, Groot N, et al. Immunogenicity and safety of the bivalent HPV vaccine in female patients with juvenile idiopathic arthritis: a prospective controlled observational cohort study[J]. Ann Rheum Dis, 2014, 73: 1500-1507. doi: 10.1136/annrheumdis-2013-203429 [16] Heijstek MW, Kamphuis S, Armbrust W, et al. Effects of the live attenuated measles-mumps-rubella booster vaccina-tion on disease activity in patients with juvenile idiopathic arthritis: a randomized trial[J]. JAMA, 2013, 309: 2449-2456. doi: 10.1001/jama.2013.6768 [17] Uziel Y, Moshe V, Onozo B, et al. Live attenuated MMR/V booster vaccines in children with rheumatic diseases on immunosuppressive therapy are safe: Multicenter, retrospective data collection[J]. Vaccine, 2020, 38: 2198-2201. doi: 10.1016/j.vaccine.2020.01.037 -
下载:
点击查看大图
图(3)
计量
- 文章访问数: 312
- HTML全文浏览量: 56
- PDF下载量: 179
- 被引次数: 0
