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Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany
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) a...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778670/ https://www.ncbi.nlm.nih.gov/pubmed/29357887 http://dx.doi.org/10.1186/s12969-018-0224-2 |
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author | 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 |
author_facet | 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 |
author_sort | Hinze, Claas H. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5778670 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-57786702018-01-31 Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany 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 Pediatr Rheumatol Online J Research Article 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. BioMed Central 2018-01-22 /pmc/articles/PMC5778670/ /pubmed/29357887 http://dx.doi.org/10.1186/s12969-018-0224-2 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article 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 Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany |
title | Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany |
title_full | Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany |
title_fullStr | Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany |
title_full_unstemmed | Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany |
title_short | Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany |
title_sort | practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in germany |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778670/ https://www.ncbi.nlm.nih.gov/pubmed/29357887 http://dx.doi.org/10.1186/s12969-018-0224-2 |
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