Juvenile Arthritis Treatment Guidelines Adopted by ACR
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.
Recommended reading:
- 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
Kelly…I have Adutlt Onset Stills Disease (AOSD) whcih closely resembles the systemic form of Juvenile Rheumatoid Arthritis…I am currently taking Actemra with great success after failing 6 other Biologics and many other medications….So I found this information to be very interesting…I also tried Kineret with no success…So I am hoping this is the correct “Miracle Drug” for me and that it will last a long time…
Thank you for all the information you publish!!!
I find it extremely helpful and interesting…
Jewell
Thanks. I thought it was so interesting that they list Kineret. It’s so rarely used. But obviously shows promise with JA.
My doctor said Kineret is used for many patients with Stills disease also with a great sucess rate…Just not for me…
Jewell
Kelly…Are you still taking Actemra too?
Just curious….
Jewell
My insurance would not pay properly for the actemra since it was new last year. I’ve heard that doctors are getting paid for it properly now that it has a proper billing code. My doctor refused to let me go back on it. That was last November. I’m waiting for something new to be approved.
Thank you for providing this information, very useful to know. Jeannine
I’m so impressed with all the choices now. I was dx with JRA at age 10, and there was aspirin. Lots of it. And weekly blood draws. So glad for the treatments available now!
Kelly,
Thank you for such an informative website! We are grateful that there is so much to read and learn from, and that the information on it is very timely. Our 14 year old daughter started Enbrel in January and got her first methotrexate added to it this week. We are hoping for her remission from aggressive sudden onset and a 7 month flare. It is comforting to know that real stories and real time information are always available on your site. Thank you doesn’t begin to say enough about how much we appreciate what you do!
Thanks, Kelly….you always keep us informed, and we appreciate your efforts so much. JRA, as with RA, is so difficult because of the problems with diagnosis and the suggested treatments—and it’s so hard to see these younger patients suffer so much on the path to getting relief for their miscellaneous pains. Someday, JRA and RA will get easier, but now we can only hope that “someday” will come along faster!