Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany
| Autor: | Hinze, Claas H., Holzinger, Dirk, Lainka, Elke, Haas, Johannes-Peter, Speth, Fabian, Kallinich, Tilmann, Rieber, Nikolaus, Hufnagel, Markus, Jansson, Annette F., Hedrich, Christian, Winowski, Hanna, Berger, Thomas, Foeldvari, Ivan, Ganser, Gerd, Hospach, Anton, Huppertz, Hans-Iko, Mönkemöller, Kirsten, Neudorf, Ulrich, Weißbarth-Riedel, Elisabeth, Wittkowski, Helmut, Horneff, Gerd, Foell, Dirk, Weller, Frank, Thon, Angelika, Lilienthal, Eggert, Lutz, Thomas, Oommen, Prasad T., Berendes, Rainer, Berrang, Jens, Tenbrock, Klaus, Rietschel, Christoph, Heubner, Georg, Küster, Rolf-Michael |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Consensus lcsh:Diseases of the musculoskeletal system Databases Factual Medizin Arthritis Biologics Biological Factors 03 medical and health sciences 0302 clinical medicine Rheumatology Systemic juvenile idiopathic arthritis Germany Internal medicine Diagnosis medicine Humans Immunology and Allergy Initial treatment Registries 030212 general & internal medicine Practice Patterns Physicians' Child Intensive care medicine Glucocorticoids 030203 arthritis & rheumatology business.industry Interleukin-1 blockade lcsh:RJ1-570 Consensus conference lcsh:Pediatrics Chronic arthritis medicine.disease Arthritis Juvenile Antirheumatic Agents Child Preschool Pediatrics Perinatology and Child Health Interleukin-6 blockade Registry data lcsh:RC925-935 business Inactive disease Treat-to-target Research Article |
| Zdroj: | PEDIATRIC RHEUMATOLOGY Pediatric Rheumatology Online Journal, Vol 16, Iss 1, Pp 1-14 (2018) Pediatric Rheumatology Online Journal |
| Popis: | Background Systemic juvenile idiopathic arthritis (SJIA) is an autoinflammatory disease associated with chronic arthritis. Early diagnosis and effective therapy of SJIA is desirable, so that complications are avoided. The PRO-KIND initiative of the German Society for Pediatric Rheumatology (GKJR) aims to define consensus-based strategies to harmonize diagnostic and therapeutic approaches in Germany. Methods We analyzed data on patients diagnosed with SJIA from 3 national registries in Germany. Subsequently, via online surveys and teleconferences among pediatric rheumatologists with a special expertise in the treatment of SJIA, we identified current diagnostic and treatment approaches in Germany. Those were harmonized via the formulation of statements and, supported by findings from a literature search. Finally, an in-person consensus conference using nominal group technique was held to further modify and consent the statements. Results Up to 50% of patients diagnosed with SJIA in Germany do not fulfill the International League of Associations for Rheumatology (ILAR) classification criteria, mostly due to the absence of chronic arthritis. Our findings suggest that chronic arthritis is not obligatory for the diagnosis and treatment of SJIA, allowing a diagnosis of probable SJIA. Malignant, infectious and hereditary autoinflammatory diseases should be considered before rendering a diagnosis of probable SJIA. There is substantial variability in the initial treatment of SJIA. Based on registry data, most patients initially receive systemic glucocorticoids, however, increasingly substituted or accompanied by biological agents, i.e. interleukin (IL)-1 and IL-6 blockade (up to 27.2% of patients). We identified preferred initial therapies for probable and definitive SJIA, including step-up patterns and treatment targets for the short-term (resolution of fever, decrease in C-reactive protein by 50% within 7 days), the mid-term (improvement in physician global and active joint count by at least 50% or a JADAS-10 score of maximally 5.4 within 4 weeks) and the long-term (glucocorticoid-free clinically inactive disease within 6 to 12 months), and an explicit treat-to-target strategy. Conclusions We developed consensus-based strategies regarding the diagnosis and treatment of probable or definitive SJIA in Germany. Electronic supplementary material The online version of this article (10.1186/s12969-018-0224-2) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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