Management for rheumatoid factor-positive polyarticular JIA

Onel, 2022Ringold, 2019

Management of rheumatoid factor (RF)–positive 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-positive 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 immunomodulatory therapy
• inducing and maintaining remission with early and aggressive therapy with disease-modifying antirheumatic drugs (DMARDs)
  • conventional synthetic DMARDs, including methotrexate and leflunomide, are used first line
  • early escalation to biological DMARDs may be required in patients who have an inadequate response to treatment with csDMARDs
• considering adjunctive intra-articular corticosteroids to treat arthritis in specific joints, particularly if joint positioning or mobility is poor, or pain is significant
• screening for JIA-associated uveitis
• 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.