Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Juvenile Idiopathic Arthritis (JIA) is one of the most common chronic pediatric rheumatic diseases (PRD). As is the case for most PRD’s, evidence-based guidelines are sparse and management is based to great extent on physician’s experience. Moreover, there are differences between nations regarding availability and financing of biological therapies. In 2012, a European initiative called SHARE (Single Hub and Access point for pediatric Rheumatology in Europe) was launched to optimize and disseminate diagnostic and management regimens in Europe for children and young adults with rheumatic diseases. One of the aims of SHARE was to provide evidence based recommendations for diagnosis and treatment of JIA.
Methods
Evidence based recommendations were developed using the European League Against Rheumatism (EULAR) standard operating procedure1. An expert committee was instituted, consisting of pediatric rheumatologists from across Europe with expertise in JIA. The expert committee defined search terms for the systematic literature review. Two independent experts scored articles for validity and level of evidence. Recommendations derived from the literature were evaluated by an online survey. Those with less than 80% agreement during the online survey were reformulated. Subsequently, all recommendations were discussed by the experts at a consensus meeting using the nominal group technique2. Recommendations were accepted if more than 80% agreement was reached.
Results
The literature search yielded 4723 articles, of which 174 were considered relevant. The included articles were scored for validity and level of evidence. Recommendations were formulated based on the valid papers and were discussed and adjusted where needed during the consensus meeting. In total, 10 recommendations for diagnosis and 31 for treatment were accepted with more than 80% agreement. Topics covered for diagnosis and for treatment are shown in Table 1.
|
[Table 1] Juvenile Idiopathic Arthritis |
|
|
Diagnosis |
Treatment |
|
The value of MRI in the diagnosis arthritis |
Steroids (locally and systemically administered) |
|
The value of ultrasound in the diagnosis of arthritis |
DMARDS |
|
Biomarkers for diagnosis of JIA |
Biologicals |
|
Diagnosis of complications |
Treatment of complications |
Conclusion
The SHARE initiative provides recommendations for diagnosis and treatment of JIA and thereby facilitates improvement and uniformity of care throughout Europe. In the subsequent phase of the project, best practices identified from literature will be completed with the ‘experts opinion’ in order to formulate diagnostic and management guidelines as best practices for care of JIA patients throughout Europe.
References:
1 Dougados, M. et al., EULAR standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations endorsed by the EULAR standing committees. Annals of the Rheumatic Diseases, 2004.
2 Van de Ven, A. H., and A. L. Delbecq, The nominal group as a research instrument for exploratory health studies. American Journal of Public Health, 1972
Disclosure:
S. J. Vastert,
None;
V. Boom,
None;
J. Anton,
None;
T. Constantin,
None;
P. Dolezalova,
Novartis Pharmaceutical Corporation,
2;
G. Horneff,
AbbVie, Pfizer, and Roche ,
2,
AbbVie, Novartis, Pfizer, and Roche,
8;
P. Lahdenne,
Abbvie, Pfizer, Roche,
8;
B. Magnusson,
None;
K. Minden,
None;
K. Nistala,
None;
P. Quartier,
AbbVie, Novartis, Pfizer, BMS, Chugai-Roche, Medimmune, Servier, and Swedish Orphan Biovitrum,
2,
AbbVie, Novartis, Pfizer, BMS, Chugai-Roche, Medimmune, Servier, and Swedish Orphan Biovitrum,
5;
I. Rumba-Rozenfelde,
None;
N. Ruperto,
European League Against Rheumatism,
2;
V. Remy Piccolo,
None;
R. A. G. Russo,
None;
Y. Uziel,
Novartis Pharmaceutical Corporation,
2,
Novartis Pharmaceutical Corporation,
5,
Abbvie, Neopharm, Novartis, Roche,
8;
C. Wouters,
None;
A. Martini,
Abbott, AstraZeneca, BMS, Centocor, Eli Lilly, Francesco Angelini s.p.a., GlaxoSmithKline, Italfarmaco, Merck Serono, Novartis, Pfizer, Regeneron, Roche, Sanofi Aventis, Schwarz Biosciences, Xoma, Wyeth,
2,
Abbott, AstraZeneca, BMS, Centocor, Eli Lilly, Francesco Angelini s.p.a., GlaxoSmithKline, Italfarmaco, Merck Serono, Novartis, Pfizer, Regeneron, Roche, Sanofi Aventis, Schwarz Biosciences, Xoma, Wyeth,
5;
A. Ravelli,
None,
8;
H. Foster,
None;
N. Wulffraat,
Abbvie, GSK, Roche,
2,
Genzyme, Novartis, Pfizer, Roche,
5.
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