Management for rheumatoid factor-negative polyarticular JIA
Management of rheumatoid factor (RF)–negative polyarticular juvenile idiopathic arthritis (JIA), under the direction of a paediatric rheumatology service, is based on a multidimensional approach that incorporates pharmacological and nonpharmacological interventions.
Management of RF-negative polyarticular JIA involves:
- referring the patient for comprehensive assessment (including blood investigations) by a specialist paediatric rheumatology service
- implementing nonpharmacological interventions such as physiotherapy to manage symptoms and maintain overall health and wellbeing
- reducing pain and stiffness with short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) while awaiting the effects of immunomodulatory therapy
- managing persistent pain and stiffness in patients treated with an NSAID with oral prednisolone (or prednisone) while awaiting the effects of other immunomodulatory therapy
- inducing and maintaining remission with a disease-modifying antirheumatic drug (DMARD), started early with specialist advice
- conventional synthetic DMARDs, including methotrexate and leflunomide, are first-line immunomodulatory therapy
- biological DMARDs may be required for children and adolescents with difficult-to-control polyarthritis
- considering adjunctive intra-articular corticosteroids to treat arthritis in specific joints, particularly if joint positioning or mobility is poor, or pain is significant
- helping adolescents achieve supported self-management before their transition into adult care
- providing the patient and their caregivers with information about the diagnosis and its management, and developing a shared understanding
- tailoring multidisciplinary care to the patient’s needs
- regularly assessing the patient’s pain intensity, function and quality of life, and the adequacy of therapy.