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Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany
Claas H Hinze1, Dirk Holzinger2,3, Elke Lainka4
1Department of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Albert-Schweitzer-Campus 1, Building W30, 48149, Münster, Germany. claas.hinze@ukmuenster.de.
Insights
Systemic juvenile idiopathic arthritis (SJIA) diagnosis may not require chronic arthritis, allowing for probable SJIA identification. Consensus strategies were developed for diagnosing and treating SJIA in Germany.
Area of Science:
- Pediatric Rheumatology
- Autoinflammatory Diseases
- Clinical Consensus
Background:
- Systemic juvenile idiopathic arthritis (SJIA) is a chronic autoinflammatory disease requiring early diagnosis and effective therapy to prevent complications.
- The PRO-KIND initiative aimed to standardize SJIA diagnostic and therapeutic approaches in Germany through consensus.
- Harmonizing care is crucial for improving outcomes in pediatric rheumatology.
Purpose of the Study:
- To develop consensus-based strategies for diagnosing and treating SJIA in Germany.
- To address the diagnostic challenges posed by the absence of chronic arthritis in some SJIA patients.
- To establish clear treatment targets and therapeutic pathways for SJIA.
Main Methods:
- Analysis of data from three German national SJIA patient registries.
- Online surveys and teleconferences with pediatric rheumatologists specializing in SJIA.
- Literature search and a consensus conference utilizing the nominal group technique.
Main Results:
- Up to 50% of diagnosed SJIA patients in Germany do not meet ILAR criteria, primarily due to lack of chronic arthritis.
- The study suggests chronic arthritis is not obligatory for SJIA diagnosis, proposing a 'probable SJIA' category.
- Identified preferred initial therapies, including systemic glucocorticoids and biologics (IL-1, IL-6 blockade), with defined short-, mid-, and long-term treatment targets.
Conclusions:
- Consensus-based strategies for the diagnosis and treatment of probable or definitive SJIA have been established in Germany.
- These strategies aim to harmonize clinical practice and improve patient care.
- The findings support a treat-to-target approach for managing SJIA.
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.
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