Childhood Arthritis and Rheumatology Research Alliance consensus treatment plans for new-onset polyarticular juvenile idiopathic arthritis.

TitleChildhood Arthritis and Rheumatology Research Alliance consensus treatment plans for new-onset polyarticular juvenile idiopathic arthritis.
Publication TypeJournal Article
Year of Publication2014
AuthorsRingold S, Weiss PF, Colbert RA, DeWitt EMorgan, Lee T, Onel KB, Prahalad S, Schneider R, Shenoi S, Vehe RK, Kimura Y
Corporate AuthorsJuvenile Idiopathic Arthritis Research Committee of the Childhood Arthritis and Rheumatology Research Alliance
JournalArthritis Care Res (Hoboken)
Volume66
Issue7
Pagination1063-72
Date Published2014 Jul
ISSN2151-4658
KeywordsArthritis, Juvenile, Child, Clinical Protocols, Consensus, Early Diagnosis, Humans, Pediatrics, Registries, Rheumatology
Abstract

OBJECTIVE: There is no standardized approach to the initial treatment of polyarticular juvenile idiopathic arthritis (JIA) among pediatric rheumatologists. Understanding the comparative effectiveness of the diverse therapeutic options available will result in better health outcomes for polyarticular JIA. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans (CTPs) for use in clinical practice to facilitate such studies.

METHODS: A case-based survey was administered to CARRA members to identify the common treatment approaches for new-onset polyarticular JIA. Two face-to-face consensus conferences employed modified nominal group technique to identify treatment strategies, operational case definition, end points, and data elements to be collected. A core workgroup reviewed the relevant literature, refined plans, and developed medication dosing and monitoring recommendations.

RESULTS: The initial case-based survey identified significant variability among treatment approaches for new-onset polyarticular JIA. We developed 3 CTPs based on treatment strategies for the first 12 months of therapy, as well as case definitions and clinical and laboratory monitoring schedules. The CTPs include a step-up plan (nonbiologic disease-modifying antirheumatic drug [DMARD] followed by a biologic DMARD), an early combination plan (nonbiologic and biologic DMARD combined within a month of treatment initiation), and a biologic only plan. This approach was approved by 96% of the CARRA JIA Research Committee members attending the 2013 CARRA face-to-face meeting.

CONCLUSION: Three standardized CTPs were developed for new-onset polyarticular JIA. Coupled with data collection at defined intervals, use of these CTPs will enable the study of their comparative effectiveness in an observational setting to optimize initial management of polyarticular JIA.

DOI10.1002/acr.22259
Alternate JournalArthritis Care Res (Hoboken)
PubMed ID24339215
PubMed Central IDPMC4467832
Grant ListK12HS019482 / HS / AHRQ HHS / United States
K23 AR059749 / AR / NIAMS NIH HHS / United States
K23-AR-059749 / AR / NIAMS NIH HHS / United States
RC1 AR058605 / AR / NIAMS NIH HHS / United States