《2021年ACR幼年特发性关节炎治疗指南》解读

Interpretation of the ACR guideline of 2021 for the treatment of juvenile idiopathic arthritis

2022年3月美国风湿病学会(ACR)发布了关于幼年特发性关节炎(JIA)治疗指南(2021年),重点描述了少关节型、颞颌关节炎以及全身型(伴或不伴巨噬细胞活化综合征)的治疗路径,也对非活动期sJIA减药给出了建议。主要阐述要点为糖皮质激素不宜在儿童患者长期使用,应尽可能在最短使用时间采用最低有效剂量进行。在考虑治疗方案时,医生与家属和患者共同决策非常重要。在疾病活动期,尽早开始生物合成的缓解疾病的抗风湿药(bDMARD)或联合传统合成缓解疾病的抗风湿药(csDMARD)治疗。非全身型JIA中,bDMARD没有首选推荐,以TNFi最常用,csDMARD以甲氨蝶呤为首选。全身型JIA以IL-1或IL-6抑制剂为首选,如果反应不佳,可予以阿巴西普、TNFi替代治疗。应注意的是,所有建议的证据评分为低质量或非常低的质量。

In March 2022,the American College of Rheumatology(ACR)published guidelines for the treatment of juvenile idiopathic joints(JIA),focusing on the treatment pathways for oligoarthritis, temporomandibular joint(TMJ)arthritis, and systemic JIA(with or without MAS).Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided.The main point is that glucocorticoids should not be used for a long time in child patients, and should be used for the shortest possible duration and at the lowest effective dose.It is important that clinical decisions should be made by the treating clinician and patient/caregiver.It is recommended that biosynthetic DMARDs(bDMARDs)or combin use with conventional synthetic DMARDs(csDMARDs)in active disease should be carried out as early as possible. In the non-systemic JIA,there is no recommendation for the optimal choice of bDMARDs.TNFi is the most commonly used and methotrexate is the first choice in csDMARD. IL-1 or IL-6 inhibitors are the first choice for systemic JIA.Abatacept and TNFi can be used as replacement therapy if response is poor. Evidence for all recommendations is graded as low or very low in quality, which should be noted.