Specific guidelines for treating juvenile idiopathic arthritis

A study published by the Cleveland Clinic and The Hospital for Sick Children (SickKids) provides the medical community for the first time with specific guidelines for treating juvenile idiopathic arthritis (JIA), previously known as juvenile rheumatoid arthritis (JRA), a condition that affects approximately one in every 1,000 children.

This study is publishing in the October 4 edition of the Journal of the American Medical Association (JAMA). JIA is characterized by the inflammation of joints. The onset of the condition typically occurs before the age of 16 and likely results from a combination of genetic and environmental factors. Although there is no cure for JIA, targeted treatment has been shown to improve symptoms significantly.

"It is important that parents and caregivers not assume that the symptoms of arthritis are simply growing pains," said Dr. Ronald Laxer, co-author of the study, vice president, Clinical and Academic Affairs and staff rheumatologist at SickKids and a professor in the Department of Paediatrics at the University of Toronto. "The most common form of juvenile idiopathic arthritis affects approximately one in a 1,000 Canadian children and if left untreated can result in significant developmental damage to the bones, joints and muscles."

The five most common types of JIA are oligoarthritis, which accounts for 50 per cent of cases and involves the swelling of less than five joints; polyarthritis, with swelling of more than five joints; systemic arthritis, characterized by high fevers and a rash with swelling of other organs in addition to joints; enthesitis-related arthritis, which may affect the spine and hips; and psoriatic arthritis, where children have psoriasis in addition to swollen joints.

Dr. Laxer and Dr. Philip D. Hashkes of the Cleveland Clinic examined more than 279 clinical studies undertaken between 1966 and 2005 to identify the most effective practices for treating the five most common types of JIA, a disease whose cause is not known.

These findings served as the basis for the guidelines published in the JAMA and could help many general paediatricians and arthritis specialists (rheumatologists) better determine how to treat their patients. To date, a clear approach for treating the different forms of the disease has not existed, despite many advances in the treatment of JIA.

"Treatment for JIA has come a long way over the last 15 years, however, there has not been a set of treatment guidelines based on patient symptoms," said Dr. Hashkes the study's principal investigator and a rheumatologist and immunologist in the Cleveland Clinic's Department of Rheumatic Diseases. "The guidelines in the JAMA study summarize the current evidence-based medical practices for JIA and provide physicians with a rational approach for treating the various subtypes of the disease. By examining a patients' symptoms physicians can determine the type of arthritis they have and what approach is most appropriate for treating their condition."