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Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology

Alberto Martini1,2, Angelo Ravelli3,4, Tadej Avcin3,4

  • 1From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands. albertomartini@gaslini.org.

The Journal of Rheumatology
|October 3, 2018
PubMed

Insights

Researchers revised juvenile idiopathic arthritis (JIA) classification criteria using an evidence-based approach. New provisional criteria were developed through international consensus to better define childhood arthritis subtypes.

Area of Science:

  • Rheumatology
  • Pediatric Rheumatology
  • Clinical Classification

Background:

  • The International League of Associations for Rheumatology (ILAR) classification criteria for juvenile idiopathic arthritis (JIA) require revision.
  • An evidence-based approach is needed to refine JIA classification using globally available clinical and laboratory measures.
  • Distinguishing childhood-specific arthritis from adult disease counterparts in children is crucial.

Purpose of the Study:

  • To revise the current JIA ILAR classification criteria.
  • To identify homogeneous clinical groups within JIA.
  • To develop new provisional JIA classification criteria using international consensus.

Main Methods:

  • The project involved a 4-step process, with Steps 1 and 2 focusing on Delphi and Nominal Group Technique (NGT) consensus.
  • Three Delphi rounds were conducted to revise the existing 7 ILAR JIA categories.
  • An international NGT consensus conference with electronic voting was used to derive new provisional criteria.

Main Results:

  • Four new provisional JIA categories were proposed: systemic JIA, rheumatoid factor-positive JIA, enthesitis/spondylitis-related JIA, and early-onset antinuclear antibody-positive JIA.
  • Other JIA forms were grouped under "others" for further analysis.
  • An international consensus was achieved on preliminary criteria for homogeneous chronic disorders within JIA.

Conclusions:

  • Preliminary international consensus was reached on revised JIA classification criteria.
  • The proposed criteria aim to better define homogeneous chronic disorders under the JIA umbrella.
  • Formal validation of these preliminary criteria will be conducted in a future dedicated project.
Abstract

Keywords:
ANTINUCLEAR ANTIBODIESAUTOIMMUNE DISEASESJUVENILE IDIOPATHIC ARTHRITIS

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