German evidence and consensus based guidelines 2010 for the treatment of juvenile idiopathic arthritis (JIA)

Background

To improve the quality of care for patients with JIA, standardization of treatment is mandatory. We present a clinical practice guideline (CPG) for the treatment of JIA. It is based on the existing CPG of 2005^* and 2008^# (^*published as book chapter; ^#peer reviewed publication: Clinical Research and Practice in Paediatrics 2008; 220: 392 - 402).

Methods

We performed a systematic literature analysis in PubMed (deadline: 15^th January 2010, terms "juvenile idiopathic (rheumatoid) arthritis", "therapy", limits: “humans”, “published in the last 3 years”, “all child 0-18 years”, “clinical trial”) and evaluated relevant studies for quality of methodology. A formal consensus process, i.e. Nominal group technique and Delphi method, was conducted at three moderated consensus conferences at Düsseldorf or Krefeld (Germany) on May 9^th, 2007, August 1^st, 2007 and January 15^th, 2010. Conferences were attended by 95% of the representatives who had been nominated by their scientific society or organizations.

Results

15 consensus statements and key notes regarding drug therapy, symptomatic and surgical management of JIA were compiled and judged strictly by the criteria of Evidence-Based Medicine (presented on the poster).

Conclusions

Currently, we recommend that JIA is treated with NSAR followed by local GC and/ or MTX as first line treatment. Other interventions e. g. the role of biologic agents, physiotherapy, and arthroscopy are discussed strictly on the basis of literature available. Our CPG will require a frequent update, as the number of randomized trials is increasing and the new potential drugs will become available.