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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.
Clinica Pediatrica e Reumatologia Università degli Studi di Genova Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina
Department of Pediatrics Asklepios Klinik Sankt Augustin
Department of Pediatric and Adolescents Medicine University Hospital of Cologne
Division od Rheumatology University of Toronto Hospital for Sick Children
Division of Rheumatology Cincinnati Children's Hospital Medical Center University of Cincinnati
Department of Paediatric Immunology Wilhelmina Children's Hospital University Medical Center Utrecht University of Utrecht
Rheumatology Unit Department of General Medicine Royal Children's Hospital Murdoch Children's Research Institute
Department of Pediatric Rheumatology King Faisal Specialist Hospital and Research Center Alfaisal University
Division of Pediatric Rheumatology Hospital Sant Joan de Déu Universitat de Barcelona
Department of Allergology Rheumatology and Clinical Immunology University Medical Center Ljubljana Medical Faculty University of Ljubljana
Division of Rheumatology Western University Children's Hospital London Health Sciences Centre
Institute of Translational Medicine University of Liverpool Alder Hey Children's NHS Foundation Trust
Rheumatology Department Hospital General de México Eduardo Liceaga
Pediatric Rheumatology Azienda Ospedaliero Universitaria Meyer
Division of Rheumatology Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù
Pediatric Rheumatology and Immunology University of Muenster
Department of Pediatrics Nippon Medical School
Institute of Clinical Medicine Children's Hospital Helsinki University Hospital
Paris-Descartes University IMAGINE Institute RAISE 22 National Reference Centre Necker-Enfants Malades Hospital Assistance Publique Hopitaux de Paris
Clinica Pediatrica e Reumatologia Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini
Servicio de Inmunología y Reumatología Hospital de Pediatría Garrahan
Reumatologia Pediátrica São Paulo State University (UNESP)
Department of Rheumatology ISIC Superspeciality Hospital Sir Ganga Ram Hospital
Red Cross War Memorial Children's Hospital University of Cape Town
Pediatric Rheumatology Seattle Children's Hospital and Research Center University of Washington
Pediatric Rheumatology Unit Department of Pediatrics Meir Medical Center
Tel Aviv University Sackler School of Medicine
Division of Rheumatology Department of Medicine3 Medical University of Vienna
Reumatologia Pediátrica São Paulo State University (UNESP)
