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Abstract Number: 284

Single Hub and Access Point for Paediatric Rheumatology in Europe (SHARE)– Evidence Based Recommendations for Diagnosis and Treatment of Juvenile Idiopathic Arthritis

S.J. Vastert1, Victor Boom2, Jordi Anton3, Tamás Constantin4, Pavla Dolezalova5, Gerd Horneff6, Pekka Lahdenne7, Bo Magnusson8, Kirsten Minden9, K. Nistala10, Pierre Quartier11, Ingrida Rumba-Rozenfelde12, Nicolino Ruperto13, Vanessa Remy Piccolo14, Ricardo A. G. Russo15, Yosef Uziel16, Carine Wouters17, Alberto Martini18, Angelo Ravelli19, Helen Foster20 and Nico Wulffraat21, 1Pediatric Rheumatology, University Medical Center Utrecht, Utrecht, Netherlands, 2Paediatric Rheumatology, University Medical Center Utrecht, Utrecht, Netherlands, 3Pediatric Rheumatology Unit. Hospital Sant Joan de Déu. Universitat de Barcelona, Barcelona, Spain, 4Pediatric Rheumatology, University Childrens Hospital, Budapest, Hungary, 5Paediatric Rheumatiology unit, 1st Faculty of Medicine, General University Hospital, Prague, Czech Republic, 6Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany, 7Paediatrics, Helsinki University Central Hospital, Helsinki, Finland, 8Pediatric Rheumatology, Astrid Lindgren Children's Hospital, Stockholm, Sweden, 9Epidemiology unit, German Rheumatism Research Center, Berlin, Germany, 10Centre for Rheumatology, University College London, London, United Kingdom, 11Pediatric Rheumatology, IMAGINE Institute, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Université Paris-Descartes, Paris, France, 12University of Latvia, Riga, Latvia, 13Pediatria II,, Istituto Giannina Gaslini, Genoa, Italy, 14Pediatric Rheumatology, Hopital Necker Enfants Malades, Paris, France, 15Immunology & Rheumatology, Hospital de Pediatria Garrahan, Buenos Aires, Argentina, 16Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel, 17University of Leuven, Laboratory of Pediatric Immunology, University Hospital Leuven, Leuven, Belgium, 18Istituto Giannina Gaslini, Genova, Italy, 19University of Genova, Genova, Italy, 20Newcastle University, Newcastle, United Kingdom, 21Paediatric Immunology and Rheumatology, University Medical Center Utrecht, Utrecht, Netherlands

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: diagnosis, guidelines, Juvenile arthritis and treatment

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Session Information

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Juvenile Idiopathic Arthritis

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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