Materiały źródłowe

• #1 Juvenile idiopathic arthritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/juvenile-idiopathic-arthritis/diagnosis-treatment/drc-20374088

  Treatment for juvenile idiopathic arthritis focuses on helping your child maintain a normal level of physical and social activity. To accomplish this, doctors may use a combination of strategies to relieve pain and swelling, maintain full movement and strength, and prevent complications. […] The medications used to help children with juvenile idiopathic arthritis are chosen to decrease pain, improve function and minimize potential joint damage. […] Typical medications include: Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve), reduce pain and swelling. […] Disease-modifying antirheumatic drugs (DMARDs). Doctors use these medications when NSAIDs alone fail to relieve symptoms of joint pain and swelling or if there is a high risk of damage in the future.

• #2 Treatments for Juvenile Arthritis | Arthritis Foundation

  https://www.arthritis.org/health-wellness/treatment/treatment-plan/ja-medical-decisions/treatments-for-juvenile-arthritis

  Treatment Options for Juvenile Arthritis […] Treatments can relieve stiff and swollen joints and put childrens symptoms into remission. […] The most common juvenile arthritis is juvenile idiopathic arthritis (JIA), which comes in different forms. Treatment depends on which of the five types of JIA your child has: […] Starting the right treatment early is important to […] achieve remission, which means there are no signs of inflammation in exams or tests. […] Medication is the foundation of treatment, but lifestyle interventions like physical therapy and diet are important, too. […] Medicines are the most important part of treatment for JIA. Without appropriate medication, the disease progress continues to cause irreversible damage to joints and possibly organs. Your child may take some or all of the following:

• #3 Juvenile Idiopathic Arthritis (JIA): Diagnosis, Treatment, and Steps to Take

  https://www.niams.nih.gov/health-topics/juvenile-arthritis/diagnosis-treatment-and-steps-to-take

  The goals of treatment are to: […] Most children with JIA need a combination of medicines and a healthy lifestyle, including a balanced diet and exercise, to reach these goals. The specific treatment plan will depend on the child’s age, the type of JIA they have, and other factors, such as disease severity. In general, doctors will treat the disease aggressively early on, gradually reducing medications once remission is reached. […] The types of medications your child may be prescribed include: […] Physical therapy can be an important part of JIA treatment. […] Regular medical care is important because the doctor can: […] Treating juvenile idiopathic arthritis typically requires a team approach that involves several different health care providers. […] JIA is primarily treated by:

• #4 Juvenile Idiopathic Arthritis (JIA) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10370-juvenile-idiopathic-arthritis

  Juvenile idiopathic arthritis (JIA) is the most common type of arthritis affecting children. Treatments include medications and physical therapy. Early intervention can help manage JIA and prevent joint damage. […] Treatment for JIA usually includes medications and exercise. The goals of treatment are to: Increase joint mobility and strength, Prevent joint damage and complications, Relieve pain, Reduce swelling. […] If your child receives a JIA diagnosis, your healthcare provider might recommend: Nonsteroidal anti-inflammatory drugs (NSAIDs). These medicines provide pain relief and reduce swelling, but they dont affect the course or outcome of JIA. […] Corticosteroids. Providers often give corticosteroid medication as an injection (shot) into a single affected joint. Sometimes, steroids are also given orally (by mouth) as a pill or liquid if many joints are affected or if a child has systemic juvenile idiopathic arthritis.

• #5 Juvenile idiopathic arthritis: management and therapeutic options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3383518/

  The goals of treatment for juvenile idiopathic arthritis (JIA) include: suppression of inflammation, achievement of remission, relief of pain, maintenance of function and doing so with minimal toxicity. […] Nonsteroidal anti-inflammatory agents still have a role in mild disease and intra-articular steroid injections continue to be used most commonly in patients with oligoarticular JIA. […] Disease-modifying agents such as methotrexate have demonstrated efficacy and safety; however, in many patients, the disease remains active despite this treatment. […] These children now receive more targeted treatment including the tumor necrosis factor alpha (TNF) inhibitors, interleukin-1 blockade, interleukin-6 blockade, selective costimulation modulators and selective B-cell blockade. […] Intra-articular corticosteroid injections (IACIs) are utilized for active arthritis, usually with a small number of active joints.

• #6 Treatment for Juvenile Idiopathic Arthritis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/juvenile-idiopathic-arthritis/treatments.html

  Treatment goals for JIA are to reduce your child’s joint pain and to prevent disability. […] Most children with JIA need to take medicine to reduce inflammation, control pain, and to help prevent more damage to the joints. Physical therapy is also part of treatment. […] Treatment depends on the type and severity of JIA. Your doctor will set up a treatment team. It may include a pediatrician, an ophthalmologist, a rheumatologist, and a physical and/or occupational therapist. […] Surgery may be used in a very small number of children with JIA who have severe joint deformity, loss of movement, or pain. […] Medicine will likely be an important part of your child’s treatment. […] Disease-modifying antirheumatic drugs (DMARDs) may be used to prevent the arthritis from getting worse and injuring bones and joints.

• #7 Treatments for Juvenile Arthritis | Arthritis Foundation

  https://www.arthritis.org/health-wellness/treatment/treatment-plan/ja-medical-decisions/treatments-for-juvenile-arthritis

  NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first treatment doctors recommend. […] Corticosteroids. Injecting corticosteroids (steroids) directly into the affected joints quickly reduces inflammation and relieves pain. […] Disease-modifying antirheumatic drugs (DMARDs). If many joints are involved or steroids and NSAIDs arent enough to calm inflammation, the doctor might add or switch your child to a DMARD. […] Biologics. These newer DMARDs are an option when methotrexate and other treatments havent helped enough, or if the disease is very severe. […] JIA medicines are strong, and they can cause serious side effects. Its important for the doctor to monitor your child every few months with blood tests as well as liver and kidney function tests. […] Movement is an important part of the treatment for JA. Physical therapy improves range of motion in the joints, strengthens muscles and helps prevent injuries.

• #8 Juvenile Idiopathic Arthritis (JIA) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10370-juvenile-idiopathic-arthritis

  Juvenile idiopathic arthritis (JIA) is the most common type of arthritis affecting children. Treatments include medications and physical therapy. Early intervention can help manage JIA and prevent joint damage. […] Treatment for JIA usually includes medications and exercise. The goals of treatment are to: Increase joint mobility and strength, Prevent joint damage and complications, Relieve pain, Reduce swelling. […] If your child receives a JIA diagnosis, your healthcare provider might recommend: Nonsteroidal anti-inflammatory drugs (NSAIDs). These medicines provide pain relief and reduce swelling, but they dont affect the course or outcome of JIA. […] Corticosteroids. Providers often give corticosteroid medication as an injection (shot) into a single affected joint. Sometimes, steroids are also given orally (by mouth) as a pill or liquid if many joints are affected or if a child has systemic juvenile idiopathic arthritis.

• #9 Juvenile idiopathic arthritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/juvenile-idiopathic-arthritis/diagnosis-treatment/drc-20374088

  DMARDs may be taken in combination with NSAIDs and are used to slow the progress of juvenile idiopathic arthritis. The most commonly used DMARD for children is methotrexate (Trexall, Xatmep, others). […] Biologic agents. Also known as biologic response modifiers, this newer class of drugs includes tumor necrosis factor (TNF) blockers, such as etanercept (Enbrel, Erelzi, Eticovo), adalimumab (Humira), golimumab (Simponi) and infliximab (Remicade, Inflectra, others). […] Corticosteroids. Medications such as prednisone may be used to control symptoms until another medication takes effect. […] Your doctor may recommend that your child work with a physical therapist to help keep joints flexible and maintain range of motion and muscle tone. […] In very severe cases, surgery may be needed to improve joint function.

• #10 Juvenile idiopathic arthritis: management and therapeutic options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3383518/

  Many studies have focused on the duration of sustained benefit after IACI which appears to vary widely. […] Investigators have found that concomitant use of methotrexate effects longer periods of remission. […] In patients with oligoarticular arthritis, 21 of 26 injected joints (81%) were in full remission at 6 months. […] The treatment of JIA has changed over the past 20 years both in the armamentarium of medications used and the approach to therapy. […] Methotrexate has been used in the treatment of JIA for nearly 20 years and has been the cornerstone of treatment for many patients with JIA. […] In many patients, the disease remains active despite treatment with IACI, NSAID and DMARDs; necessitating treatment with biologic therapies. […] Biologics that are currently being used include the anti-tumor necrosis factor alpha (anti-TNF) agents (etanercept, adalimumab, infliximab), agents that target interleukin (IL)-1 (anakinra, rilonacept, canakinumab), inhibitors of T-cell costimulation (abatacept), agents that target the IL-6 receptor (tocilizumab) and agents that inhibit CD20 B cells (rituximab). […] The biologic targeted therapies have changed the strategy in which we treat patients with JIA; however, there is much to be learned about these medications.

• #11 Juvenile Idiopathic Arthritis (JIA) – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/rheumatologic-disorders-in-children/juvenile-idiopathic-arthritis-jia

  Juvenile idiopathic arthritis is a group of rheumatic diseases characterized by arthritis that begins by age 16. […] Treatment involves disease-modifying antirheumatic medications and, occasionally, corticosteroids. […] Similar to treatment of adult rheumatoid arthritis, disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate and the biologic agents (eg, etanercept, anakinra, canakinumab, tocilizumab, abatacept), have dramatically changed the therapeutic approach. […] Methotrexate is useful for oligoarticular, psoriatic, and polyarticular forms of JIA. […] TNF inhibitors are used if methotrexate is not effective or if patients are at high risk of a poor outcome. […] The IL-1 inhibitors anakinra and canakinumab are particularly effective for systemic JIA. […] Abatacept, a T-cell costimulation inhibitor, and a Janus kinase inhibitor, such as tofacitinib or upadacitinib, are also options for the treatment of polyarticular JIA.

• #12 New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis | Volume 26 – Issue 1 – January 2011 | Archives of Rheumatology

  https://tjr.org.tr/full-text/393

  Abatacept (Orencia/CTLA4-Ig) is a fully human, soluble fusion protein with a unique mechanism of action. Abatacept consists of the extracellular domain of the cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and the Fc portion of the immunoglobulin G1 (IgG1). […] Autologous stem cell transplantation has been used in patients with severe resistant JIA. For children with severe disease who fail to achieve disease control despite the use of multiple drugs including anti-TNF and anti- IL-6 receptor treatment, both allogenic and ASCT may offer an alternative option for disease remission. However, the procedure still carries a high mortality rate for an illness that does not typically have a fatal outcome. […] In conclusion, juvenile idiopathic arthritis is the most common rheumatic childhood disease that is associated with significant morbidity including functional disability and ocular damage. Prior to the era of biologicals, more than 25% of polyarticular and nearly 50% of systemic patients with JIA had functional limitations, and two-thirds had radiographically evident damage five years after onset. New and exciting alternative medications are emerging for children resistant to standard therapy. New data from large RCTs have showed the efficacy of TNF- inhibitors, the T-cell costimulation modifier abatacept, and leflunomide for the treatment of polyarticular JIA. Anti-IL-1 and anti-IL-6 biologicals, particularly for SOJIA patients, look very promising as well. The mAbs to TNF- appear to be more effective in treating chronic uveitis associated with JIA than etanercept; however, treatment still needs to be developed. The hope is that recent changes in treatment approaches will result in marked improvement in long-term functional outcomes of patients with JIA.

• #13 Juvenile Idiopathic Arthritis (JIA) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10370-juvenile-idiopathic-arthritis

  Disease-modifying anti-rheumatic drugs (DMARDs). These medications work by changing the actual disease process in arthritis. The aim of DMARD therapy is to suppress an immune attack on your childs bones and joints. […] Biological modifying agents. These medications target molecules or proteins that cause inflammation. They often recommend this treatment for children with severe symptoms that havent improved with other medications. […] Exercise (including physical and occupational therapy) can help reduce pain, maintain muscle tone, improve mobility (ability to move) and prevent permanent complications. In some cases, a provider might use splints or braces to help protect your childs joints as they grow. […] With early detection and treatment, its possible to manage the arthritis, prevent joint damage, and allow normal or near-normal function for most children with JIA.

• #14 New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis | Volume 26 – Issue 1 – January 2011 | Archives of Rheumatology

  https://tjr.org.tr/full-text/393

  Biologic agents have been designed to target key cytokines implicated in JIA including tumor necrosis factor- (TNF-), Interleukin-1 (IL-1), and IL-6 as well as signaling molecules involved in the regulation of T-cell and B-cell lymphocyte responses. In general TNF- inhibitors are more beneficial for children with polyarticular disease than in those with SOJIA. This difference may be due to different cytokines underlying the inflammatory response for each subtype of disease. Interleukin-1 and IL-6 rather than TNF- may be the predominant proinflammatory cytokines in SOJIA. Thus, biological agents that target IL-1 and IL-6 activity appear to be more successful in treating patients with SOJIA. […] Tumor necrosis factor- inhibitors are biological agents that block the immunological effects of this inflammatory mediator. Inhibitors of TNF- were evaluated for efficacy in controlling JIA and have been shown to be highly effective in the treatment of JIA patients whose disease has been unresponsive to traditional therapies. It has become common practice to move directly to anti-TNF therapy for the treatment of arthritis in children who have failed to respond adequately to MTX or who have been unable to tolerate MTX due to adverse effects. There are three TNF- inhibitors available for clinical use in the treatment of JIA: Etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira).

• #15 New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis | Volume 26 – Issue 1 – January 2011 | Archives of Rheumatology

  https://tjr.org.tr/full-text/393

  Etanercept (Enbrel) is a soluble p75 TNF receptor fusion protein coupled to the Fc (fragment crystallizable region) fragment of immunoglobulin G1 (IgG1) that acts competitively to inhibit the binding of both TNF- and TNF- to their cell surface receptors. Etanercept binds its target cytokine only when it is in serum and lowers the quantity of free TNF- available for the maintenance of the inflammatory synovitis of JIA. Etanercept is administered as a subcutaneous injection 1-2 times per week. The TNF inhibitor etanercept is the first biological approved by the U.S. Food and Drug Administration (FDA) for treatment of moderate to severe polyarticular JIA in children aged two years and older. It can be used alone or as an adjunct to MTX. […] Currently, little is known about when or how to stop etanercept in patients with JIA when a good clinical response is reached. Prince et al. suggest that patients with JIA should meet the criteria of clinical remission of medication for at least 1.5 years before considering discontinuation of etanercept and then taper off it carefully.

• #16 New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis | Volume 26 – Issue 1 – January 2011 | Archives of Rheumatology

  https://tjr.org.tr/full-text/393

  Anakinra (Kineret) is a recombinant IL-1 receptor antagonist (IL-1 Ra) that is approved for use in RA. Because of its short half-life, it is administered daily by subcutaneous injection (1-2 mg/kg/day). […] Rilonacept (IL-1 Trap/Arcalyst) is a long-acting IL-1 blocker currently undergoing trials in children with SOJIA. Rilonacept is a recombinant fusion protein that combines IL-1 receptor protein components with the Fc portion of the human immunoglobulin molecule. Unlike anakinra, which requires daily dosing, rilonacept is administered once a week. […] Canakinumab (ACZ885) is a fully humanized mAb which binds specifically to the isoform of IL-1 (IL-1) and neutralizes the bioactivity of human IL-1. It is administered as either a subcutaneous injection or an intravenous infusion. […] Tocilizumab (Roactemra/Actemra/MRA) is a recombinant humanized monoclonal antibody that acts as an IL-6 receptor antagonist that has not yet been approved by the FDA for the treatment of RA or JIA.

• #17 Juvenile Idiopathic Arthritis Treatment Roundup: What’s Available and What’s Upcoming? – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/features/juvenile-idiopathic-arthritis-jia-treatment-therapy-strategies-updates-future/

  An ongoing trial (PASCAL study; ClinicalTrials.gov Identifier: NCT01550003) is investigating the use of certolizumab pegol, a pegylated antitumor necrosis factor (TNF) inhibitor, for the treatment of polyarticular JIA. […] In September 2020, the Janus kinase (JAK) inhibitor tofacitinib received FDA approval for the treatment of active polyarticular-course JIA. […] The IL-1 receptor antagonist anakinra has been approved by the European Medicines Agency (EMA) as a first-line monotherapy for the treatment of systemic JIA. […] The IL-1 inhibitor canakinumab and the IL-6 inhibitor tocilizumab have received EMA and FDA approval for systemic JIA treatment, […] Emerging reports have also suggested the potential benefits of the exogenous IL-18 binding protein in the treatment of refractory systemic JIA.

• #18 Juvenile Arthritis – Types and Treatments – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/juvenile-arthritis/

  Biologic agents are a class of drugs that also slow or stop the progression of the disease. These medications are typically used if DMARDs are insufficient, but they are sometimes used as initial treatment if the disease is severe. […] Corticosteroids are stronger medications that may be used in treating severe juvenile arthritis quickly. They can be given several ways, including by mouth (orally), injected into a vein (intravenously), or injected directly into a joint. However, corticosteroids can interfere with a child’s growth, and cause weight gain, weakening of the bones, and increased susceptibility to infections. […] Surgery is rarely needed in treating juvenile arthritis. In very severe forms of juvenile arthritis or with very severe complications, surgery may be necessary to improve the position of the joint. An example of this might be when a joint has become deformed.

• #19 Surgical Treatment of Juvenile Idiopathic Arthritis in the Era of Novel Drug Therapies

  https://www.mdpi.com/2077-0383/12/10/3402

  The indication for synovectomy is a joint that does not respond to a well-managed drug treatment, with synovial hyperplasia, persistent effusion after intra-articular corticosteroid injection, and pain. Arthroscopy should be preferred to open synovectomy. Early rehabilitation helps to restore joint range of motion. […] Surgical soft tissue release can be considered for children with a severe functional impairment. […] For end-stage joint degeneration, arthroplasty is indicated, and can provide significant improvements in function, pain relief, and quality of life.

• #20 Guide | Physical Therapy Guide to Juvenile Idiopathic Arthritis | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-juvenile-idiopathic-arthritis

  Physical therapy can be effective to help people with JIA manage their activity and exercise, which is key to reducing the symptoms of JIA, including pain and stiffness. […] A physical therapist can provide guidance on activity to help relieve pain. […] Your child’s physical therapist can provide pain-reducing activities and education on stretching. […] They can help to prevent complications such as joint deformities. […] Your physical therapist will use the best available evidence to develop a treatment program for their specific needs, challenges, and goals. […] Your physical therapy program may include patient and family education. […] Your physical therapist may use their hands to assess joint function and provide gentle stretching and joint mobility exercise to promote increased range of motion and pain relief.

• #21 Guide | Physical Therapy Guide to Juvenile Idiopathic Arthritis | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-juvenile-idiopathic-arthritis

  Strengthening is an important part of managing JIA and for recovery from any injuries. […] Your physical therapist may have access to a pool to provide aquatic therapy. […] Surgery for JIA is not likely to be needed. […] Your physical therapist will help manage flares with activity modification, equipment such as assistive devices (cane, walkers, etc.), stretching, and other guided activity. […] You may want to consider seeing a physical therapist who is experienced in treating pediatrics and arthritis.

• #22

  https://journals.lww.com/ijru/fulltext/2023/18001/role_of_rehabilitation_in_comprehensive_management.7.aspx

  Juvenile idiopathic arthritis (JIA), the most common chronic rheumatological disorder in children, can result in significant disability and poorer health-related quality of life. Rehabilitation aimed at pain management, optimizing musculoskeletal function, improving endurance and achieving independence in activities of daily living, and participation in age-appropriate activities, is a vital component in the comprehensive management of children with this condition. […] Rehabilitation strategies depend on the phase of the disease and focus on pain alleviation in the active phase and improving mobility and function in the inactive phase. Rehabilitation in JIA is multidisciplinary and includes exercise therapy, physical modalities, orthotic and assistive devices, and gait training. […] Exercise therapy has demonstrated improvement in muscle strength, bone mineral density, exercise capacity, and quality of life, without negative consequences of pain or exacerbation of arthritis.

• #23 Integrative Approaches to the Management of Juvenile Idiopathic Arthritis: A Comprehensive Review

  https://www.rupahealth.com/post/integrative-approaches-to-the-management-of-juvenile-idiopathic-arthritis-a-comprehensive-review

  In addition to making dietary modifications, some supplements may help support inflammation management and comfort in children with JIA. Vitamin D, fish oil, glutamine, and turmeric show promise for supporting joint health and comfort. Individual regimens and dosing for children should be specified by a qualified practitioner to individualize the approach. […] Hydrotherapy is a type of physical therapy that employs aquatic exercises. Exercises in a warm pool can provide gentle resistance and buoyancy to relieve pressure on joints while improving strength and flexibility. Studies suggest hydrotherapy can also help children with JIA improve the distribution of weight and plantar pressure, as well as provide social and psychological benefits. […] Various mind-body techniques are used to help manage stress and cope with pain. Self-regulatory mind-body techniques like progressive muscle relaxation, guided imagery, and meditative breathing may reduce pain intensity and improve function for patients with JIA. Studies show that these strategies led to a substantial reduction of pain intensity when practiced by children with JIA over six to 12 months.

• #24 Treatments for Juvenile Arthritis | Arthritis Foundation

  https://www.arthritis.org/health-wellness/treatment/treatment-plan/ja-medical-decisions/treatments-for-juvenile-arthritis

  Walking, swimming, and other low-impact activities strengthen muscles and maintain flexibility without injuring joints. […] Both heat and cold help joints feel better. […] Although there isnt a specific diet for JA, eating a mix of healthy nutrients will help childrens health overall. […] Vaccinations protect children from illnesses like the flu, measles and rubella. […] Kids with arthritis rarely need surgery. Treatment with DMARDs should protect their joints enough to avoid it.

• #25

  https://journals.lww.com/ijru/fulltext/2023/18001/role_of_rehabilitation_in_comprehensive_management.7.aspx

  Common exercise interventions for children with JIA include mobilization, strengthening, aerobic exercises, Pilates-based exercises, aquatic therapy, and recreation. […] Physical modalities such as thermotherapy, cryotherapy, electrotherapy, ultrasound, and low-power laser therapy are commonly employed. […] Orthotic devices play an important role in joint protection, prevention and reduction of joint deformities, and assistance with function and gait. […] Assistive devices are prescribed to improve functional ability and independence in activities of daily living in children with disabilities. […] Rehabilitation is a vital component in the comprehensive management of children with JIA. Rehabilitation strategies depend on the phase of the disease and focus on pain alleviation in the active phase and improving mobility and function in the inactive phase. Rehabilitation in JIA is multidisciplinary and includes exercise therapy, physical modalities, orthotic and assistive devices, and gait training.

• #26 Treatment for Juvenile Idiopathic Arthritis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/juvenile-idiopathic-arthritis/treatments.html

  Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce inflammation and pain, especially before DMARDs can take effect. […] A corticosteroid pill or a corticosteroid shot into a joint is sometimes used. […] Combinations of medicines may also be used. […] Treatment may include: Physical therapy. Regular exercise and range-of-motion exercises will help maintain joint range and muscle strength. And it will prevent shortening of the muscle or other tissue (contractures). […] Occupational therapy. An occupational therapist (OT) can help your child learn ways to do self-care activities, play, and take part in school without making symptoms worse. OT will also teach you and your child about using splints and casts. […] A pain management plan. This can help you and your child control pain caused by JIA. The plan may include heat, cold, or water therapy. Some people try complementary medicine, such as massage, guided imagery, and acupuncture. […] Treatment depends on the type of JIA and how severe it is. Even when JIA is uncomplicated, an affected child may need years of medical treatment or checkups. […] So part of your child’s treatment plan should be regular checkups with an ophthalmologist.

• #27 Juvenile Arthritis – Types and Treatments – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/juvenile-arthritis/

  Joint replacement frequently used to treat adults with arthritis has almost no place in treating children. In addition, adequate treatment of juvenile arthritis will protect the joint and prevent long-term damage that may ultimately require joint replacement. […] There are many treatment options for juvenile arthritis. The primary goal of all treatment options is to bring about remission of the arthritis. Remission means the child should not have any swelling or inflammation detected by exam or imaging.

• #28 Juvenile Idiopathic Arthritis Treatment & Management: Approach Considerations, History of Arthritis in 4 or Fewer Joints, History of Arthritis in 5 or More Joints

  https://emedicine.medscape.com/article/1007276-treatment

  For systemic JIA with features suggesting macrophage activation syndrome (MAS), initial treatment should include anakinra, a calcineurin inhibitor, or systemic glucocorticoid monotherapy for up to 2 weeks. […] Updated companion guidelines from the ACR address the treatment of oligoarthritis and temporomandibular joint (TMJ) arthritis. Among the recommendations are the following: For oligoarticular and TMJ arthritis, NSAIDs are conditionally recommended and intra-articular glucocorticoids (IAGCs) are strongly recommended as initial therapy; triamcinolone hexacetonide is the preferred agent for oligoarticular arthritis. […] For patients with oligoarticular or TMJ arthritis who do not respond to or cannot tolerate NSAIDs or IAGCs, conventional synthetic DMARDs are strongly recommended; methotrexate is conditionally recommended over leflunomide for TMJ arthritis and over leflunomide, sulfasalazine, and hydroxychloroquine for oligoarticular arthritis. […] ACR guidelines on nonpharmacologic approaches strongly recommend immunizations (live and inactivated) for patients with JIA who are not receiving immunosuppressive therapy.

• #29 Juvenile Idiopathic Arthritis Treatment & Management: Approach Considerations, History of Arthritis in 4 or Fewer Joints, History of Arthritis in 5 or More Joints

  https://emedicine.medscape.com/article/1007276-treatment

  A team-based approach can be helpful. Management may include one or all of the following areas: Pharmacologic management consisting of nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biologic agents, and intra-articular and oral steroids. […] American College of Rheumatology (ACR) criteria for complete remission are as follows: No inflammatory joint pain, No morning stiffness, No fatigue, No synovitis, No progression of damage, as determined in sequential radiographic examinations, No elevation of the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. […] The ACR issued recommendations for the treatment of JIA on the basis of the following 5 treatment groups: History of arthritis in 4 or fewer joints, History of arthritis in 5 or more joints, Active sacroiliac arthritis, Systemic arthritis without active arthritis, Systemic arthritis with active arthritis.

• #30 Juvenile Idiopathic Arthritis Treatment Roundup: What’s Available and What’s Upcoming? – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/features/juvenile-idiopathic-arthritis-jia-treatment-therapy-strategies-updates-future/

  In the recent years, treatment options and outcomes for patients with juvenile idiopathic arthritis (JIA) have improved considerably. […] It is important to understand the reasonably good evidence base for therapies currently available, as the appropriate use of biologics and timely intervention in refractory patients are key to effective management of JIA, he told us in an interview. […] For patients with polyarticular-course JIA, methotrexate is often used in combination with biologics to potentiate their effect and to reduce the likelihood of developing antidrug antibodies that can impact drug efficacy, the authors of the review wrote. […] In September 2020, the US Food and Drug Administration (FDA) announced the approval of intravenous golimumab for the treatment of polyarticular and psoriatic JIA.

• #31 Juvenile Idiopathic Arthritis Treatment & Management: Approach Considerations, History of Arthritis in 4 or Fewer Joints, History of Arthritis in 5 or More Joints

  https://emedicine.medscape.com/article/1007276-treatment

  Within each treatment group, choice of therapy is guided by the severity of disease activity and the presence or absence of features indicating a poor prognosis. […] The ACR released updated guidelines for the treatment of systemic JIA, which include the medications canakinumab, rilonacept, and tocilizumab. These guidelines include the following treatment recommendations: For systemic JIA with active systemic features and varying degrees of synovitis, initial treatment for most patients should consist of anakinra with systemic glucocorticoids. […] For systemic JIA without active systemic features and with varying degrees of active synovitis, initial treatment should be methotrexate or leflunomide for an active joint count higher than 4, with a change to abatacept, anakinra, a tumor necrosis factor (TNF)- inhibitor, or tocilizumab if disease activity continues after 3 months; for patients with 4 or fewer active joints, NSAID monotherapy or intra-articular glucocorticoid injections should be initial treatment.

• #32 Treatment of systemic juvenile idiopathic arthritis | Nature Reviews Rheumatology

  https://www.nature.com/articles/s41584-023-01042-z

  Systemic juvenile idiopathic arthritis (sJIA) is an inflammatory disease with hallmarks of severe systemic inflammation, which can be accompanied by arthritis. […] State-of-the-art therapeutic approaches include biologic agents that target the IL-1 and IL-6 pathways. […] Treatment of systemic juvenile idiopathic arthritis (sJIA) has evolved markedly over the past two decades, and most patients can be effectively treated using drugs that target the IL-1 or the IL-6 pathways. […] Early diagnosis is very important so that effective, targeted therapy can be started as soon as possible, which might positively influence the long-term disease course (window of opportunity). […] Many patients do not have arthritis at disease onset but nevertheless might benefit substantially from targeted therapies, thus preventing, rather than treating, arthritis.

• #33 Juvenile idiopathic arthritis (JIA) | Symptoms, treatments

  https://versusarthritis.org/about-arthritis/conditions/juvenile-idiopathic-arthritis/

  The aim of treatment for juvenile idiopathic arthritis (JIA) is to: […] control the symptoms of arthritis […] enable you to lead an active life at school or college […] enable you to enjoy an active family and social life […] help you become an independent adult. […] Drugs cant cure arthritis, but they can control the symptoms and help to reduce the possibility of joint damage. An increasing number of medicines are now available. […] Non-steroidal anti-inflammatory drugs (NSAIDs) often help to reduce pain, stiffness and swelling. […] Disease-modifying anti-rheumatic drugs (DMARDs) dampen down inflammation and can reduce the joint damage caused by arthritis. […] Biological therapies is a name given to some newer drugs that have been available for about 10 years. […] Steroids control inflammation, pain and stiffness. […] Eye drops will be used if you have eye inflammation. […] The treatment for uveitis is steroid eye drops. The drugs methotrexate and adalimumab can also treat it.

• #34 Juvenile Idiopathic Arthritis Treatment Roundup: What’s Available and What’s Upcoming? – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/features/juvenile-idiopathic-arthritis-jia-treatment-therapy-strategies-updates-future/

  Ongoing trials are examining the efficacy of tofacitinib and baricitinib for patients with systemic JIA. […] In addition, a phase 2 open-label, single-arm trial (ClinicalTrials.gov Identifier: NCT03311854) is currently investigating the use of emapalumab in pediatric patients with systemic JIA and macrophage activation syndrome. […] Ramanan and colleagues conducted a study in which adalimumab combined with methotrexate demonstrated positive effects in patients with JIA-associated uveitis; […] In another trial of 25 patients, tocilizumab was associated with improved uveitis activity in 68% of patients at 3 months and 88.2% of patients at 12 months, with significant reductions in the dose of daily median prednisolone. […] A small case series indicated positive results with JAK inhibitors among patients with JIA-associated uveitis.

• #35 Treatment of non-systemic juvenile idiopathic arthritis | Nature Reviews Rheumatology

  https://www.nature.com/articles/s41584-024-01079-8

  Contemporary therapeutic goals include early achievement of disease control, sparing use of glucocorticoids and the prevention of disease-related and treatment-related morbidity. […] The application of the treat-to-target strategy, an innovative treatment modality that has already been explored successfully in pivotal therapeutic studies, is now garnering increased interest. […] The variability in clinical presentation and course of juvenile idiopathic arthritis implies that the therapeutic choices, optimal targets and treatment strategy might be different across disease categories. […] The research agenda calls for innovative trials that improve remission rates and pave the way for refined precision studies, personalized medicine and, ultimately, future prevention.

• #36 Treatment of systemic juvenile idiopathic arthritis | Nature Reviews Rheumatology

  https://www.nature.com/articles/s41584-023-01042-z

  Treat-to-target is an attractive strategy in sJIA, fusing both individualization and standardization of treatment. […] There is a substantial gap in knowledge and effective treatment options for patients with complicated sJIA, including patients with recurrent macrophage activation syndrome, sJIA-associated lung disease, and chronic, destructive arthritis.

• #37 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-and-Treatment-of-Juvenile-Idiopathic-Arthritis.aspx

  Psychological support may be required for children who are suffering from depression or anxiety, as well as those who have significant pain. […] Permanent disability or pain may indicate the need for corrective surgery such as joint replacement. […] Genetic testing is currently being evaluated for its usefulness in predicting disease course as well as in selecting the optimal therapy for various forms of JIA.

• #38 Juvenile Idiopathic Arthritis

  https://www.printo.it/pediatric-rheumatology/IE/info/2/Juvenile-Idiopathic-Arthritis

  Methotrexate represents the second level drug of first choice worldwide for children with JIA. […] Corticosteroids are the most effective available anti-inflammatory drugs but their use is limited because, in the long-term, they are associated with several significant side effects, including osteoporosis and stunted growth. […] New perspectives have been introduced in the last few years with drugs known as biologic agents. […] Physical therapy and rehabilitation is an essential component of management; it includes appropriate exercises as well as, when indicated, the use of splints to maintain joint position in a comfortable posture to prevent pain, stiffness, muscle contractures and joint deformities. […] Today, there are international and national recommendations that help physicians and families to select the treatment.

• #39 Integrative Approaches to the Management of Juvenile Idiopathic Arthritis: A Comprehensive Review

  https://www.rupahealth.com/post/integrative-approaches-to-the-management-of-juvenile-idiopathic-arthritis-a-comprehensive-review

  Integrative medicine can be used to help balance the inflammation involved in JIA, manage pain, and improve the child’s quality of life. Diet and lifestyle approaches like an anti-inflammatory diet and balanced exercise can help improve the quality of life and function in children with JIA. An individualized treatment approach guided by clinical symptoms and functional laboratory testing can tailor a dietary and lifestyle approach that works for each child. […] An essential step in managing JIA in children and adolescents is to consider factors that may contribute to the increased chronic inflammation involved in this condition. This includes addressing an imbalanced diet, nutrient deficiencies, and chronic stress from a poor diet that may contribute to an imbalanced microbiome, leaky gut, and increased inflammation.

• #40 How New Therapies Are Revolutionizing the Treatment of Juvenile Idiopathic Arthritis | Rutgers University

  https://www.rutgers.edu/news/how-new-therapies-are-revolutionizing-treatment-juvenile-idiopathic-arthritis

  The use of biologic and targeted therapies for children with juvenile idiopathic arthritis (JIA) surpassed more typical therapies in recent years, according to Rutgers Health researchers. […] Treatments for JIA aim to alleviate symptoms; normalize physical movement and growth; prevent long-term damage and vision loss; and maximize quality of life. […] Fortunately, the therapeutic landscape has changed dramatically in recent years, and people with JIA have more potentially effective options for treatment. […] Newer disease-modifying antirheumatic drugs, while often more expensive, are frequently more effective and better tolerated by patients than older conventional agents. […] Initiations of conventional therapies declined by more than 45%, increasingly eclipsed by the use of newer biologic or targeted therapies.

• #41 How New Therapies Are Revolutionizing the Treatment of Juvenile Idiopathic Arthritis | Rutgers University

  https://www.rutgers.edu/news/how-new-therapies-are-revolutionizing-treatment-juvenile-idiopathic-arthritis

  Use of adalimumab, one of the most popular biologics on the market today, has risen steadily since its initial approval for rheumatoid arthritis in 2002, representing nearly 80% of first-line biologic or targeted therapies started for JIA by 2022. […] This research sets the stage for future studies that will compare the effectiveness and safety of different therapies used to treat JIA.

• #42 Treatment of non-systemic juvenile idiopathic arthritis | Nature Reviews Rheumatology

  https://www.nature.com/articles/s41584-024-01079-8

  In the past two decades, the treatment of juvenile idiopathic arthritis (JIA) has evolved markedly, owing to the availability of a growing number of novel, potent and relatively safe therapeutic agents and the shift of management strategies towards early achievement of disease remission. […] However, JIA encompasses a heterogeneous group of diseases that require distinct treatment approaches. […] Furthermore, some old drugs, such as methotrexate, sulfasalazine and intraarticular glucocorticoids, still maintain an important therapeutic role. […] In the past 5 years, information on the efficacy and safety of drug therapies for JIA has been further enriched through the accomplishment of several randomized controlled trials of newer biologic and synthetic targeted DMARDs. […] A multinational collaborative effort has led to the development of the recommendations for the treat-to-target strategy in JIA.

• #43

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?Hwid=hw104391

  Even when JIA isn’t severe, your child may still need long-term treatment. To make sure that treatment is right for your child, work closely with the medical team. Learn as much as you can about your child’s disease and treatments. Stay on a schedule with your child’s medicines and exercise. […] You can do a lot at home to help your child relieve his or her symptoms and prevent JIA from causing problems. […] Follow a medicine schedule. An older child may find it easier to remember to take medicine by using a pillbox or chart for a day’s or week’s worth of medicine. […] Help manage your child’s stiffness. Apply heat to stiff and painful joints for 20 minutes, and repeat as needed. You can use hot water bottles. Or make hot packs from towels dipped in warm water or wet towels microwaved for 15 to 30 seconds. Always make sure that hot water bottles and hot packs aren’t too hot for your child’s skin. Keep a cloth between the hot water bottle and your child’s skin. Don’t use heat if your child’s joints are red and warm. […] Encourage your child to take a warm bath or shower first thing in the morning. It can help ease stiffness. Have your child stretch gently afterward.

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