Parents of children with juvenile forms of Rheumatoid Arthritis have tough decisions to make. They must consider possible risks of medical treatments like TNF-a without comfortable long-term safety records. Families weigh the risks against almost certain damage, disability, and deformity that the disease can bring. Rheumatologists who advise families with these decisions got some help from the ACR this spring.
First guidelines for Juvenile Arthritis
The American College of Rheumatology (ACR) has published new guidelines for the monitoring and treatment of Juvenile Arthritis / JIA / JRA. This is the first guide they have created for “the initiation and safety monitoring of multiple medications used in the treatment” of Juvenile Arthritis.
The guidelines were developed by Dr. Timothy Beukelman, assistant professor of pediatrics in the Division of Pediatric Rheumatology at the University of Alabama. Beukelman’s team examined more than 200 studies, evaluating medical decisions related to the care of Juvenile Arthritis Patients, weighing risks and benefits of various treatments.
Dr. Beukelman told the ACR: “Our goal was to provide evidence and consensus-based guidance that reflects the current state of the field and is useful to clinicians of all levels of experience with the treatment of JIA. The recommendations are important because the treatment of JIA has undergone major changes over the last decade with the introduction of biologic therapeutic agents.”
Some recommendations for treating juveniles with Biologics
According to the ACR, the most notable recommendations include:
- Beginning treatment with TNF-α inhibitors in children with a history of arthritis in four or fewer joints and significant active arthritis despite treatment with methotrexate
- Beginning treatment with TNF-α inhibitors in children with a history of arthritis in five or more joints and any active arthritis following an adequate trial of methotrexate
- Beginning treatment with anakinra (Kineret) in children with systemic arthritis and active fever whose treatment requires a second medication in addition to systemic glucocorticoids
Note: FDA approves Actemra for Juvenile Arthritis treatment
Last week, the FDA added Juvenile Arthritis the approved uses for Actemra, a new Biologic that works differently than the TNF-a blockers. This follows a successful Actemra trial of 112 juvenile patients. Eighty-five percent of Juvenile Arthritis patients experienced a t least a 30% improvement of symptoms; 24% of those on placebo improved.
This news closely follows the establishment of the treatment guidelines. I wonder how the use of the new drug Actemra will be added to them. In adults, Actemra is used after other treatments have failed to bring improvement.
- Some Rheumatologists Don’t Understand How Much It Hurts
- Juvenile Rheumatoid Arthritis (JRA) and Rheumatoid Arthritis
- Interview with a young woman living with Rheumatoid Arthritis, Part 1
- Posts about Actemra