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Canadian Rheumatology Association Recommendations for the Screening, Monitoring, and Treatment of Juvenile Idiopathic
Roberta Berard1, Hon Yan Ng2, Andrea Human3
1R. Berard, MD, MSc, Division of Rheumatology, and Department of Pediatrics, Western University, London, Ontario; roberta.berard@lhsc.on.ca.
Insights
Canadian guidelines for juvenile idiopathic arthritis (JIA) uveitis screening, monitoring, and treatment were developed. These recommendations consider cost, equity, and access for Canadian patients.
Area of Science:
- Ophthalmology
- Pediatric Rheumatology
- Clinical Practice Guidelines
Background:
- Uveitis is a common complication of juvenile idiopathic arthritis (JIA).
- Standardized recommendations are needed for Canadian healthcare providers managing JIA-associated uveitis.
- Existing guidelines require adaptation to the Canadian healthcare context.
Purpose of the Study:
- To develop Canadian-specific recommendations for screening, monitoring, and treating uveitis in patients with JIA.
- To adapt existing guidelines using a rigorous methodology that incorporates stakeholder input.
Main Methods:
- The Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach was utilized.
- A multidisciplinary working group, including patient representatives, adapted existing recommendations.
- Evidence-to-decision tables and surveys informed consensus-building, with a health equity framework applied throughout.
Main Results:
- Seven of 19 recommendations required significant discussion regarding the Canadian context.
- Key discussion points included screening intervals, treatment escalation, and the role of nonbiologic therapies.
- Health equity considerations related to access to care across Canadian provinces were highlighted.
Conclusions:
- Canadian recommendations for JIA-associated uveitis were successfully adapted.
- The adapted guidelines integrate expert opinion, patient input, and considerations of cost, equity, and access.
- These recommendations aim to optimize care for Canadian children with JIA and uveitis.
Objective:
To develop Canadian recommendations for the screening, monitoring, and treatment of uveitis associated with juvenile idiopathic arthritis (JIA).
Methods:
Recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach. A working group of 14 pediatric rheumatologists, 6 ophthalmologists, 2 methodologists, and 3 caregiver/patient representatives reviewed recent American College of Rheumatology (ACR)/Arthritis Foundation (AF) recommendations and worked in pairs to develop evidence-to-decision (EtD) tables. A survey to assess agreement and recommendations requiring group discussion was completed. EtD tables were presented, discussed, and voted upon at a virtual meeting, to produce the final recommendations. A health equity framework was applied to all aspects of the adolopment process including the EtD tables, survey responses, and virtual meeting discussion.
Results:
The survey identified that 7 of the 19 recommendations required rigorous discussion. Seventy-five percent of working group members attended the virtual meeting to discuss controversial topics as they pertained to the Canadian environment, including timing to first eye exam, frequency of screening, escalation criteria for systemic and biologic therapy, and the role of nonbiologic therapies. Equity issues related to access to care and advanced therapeutics across Canadian provinces and territories were highlighted. Following the virtual meeting, 5 recommendations were adapted, 2 recommendations were removed, and 1 was developed de novo.
Conclusion:
Recommendations for JIA-associated uveitis were adapted to the Canadian context by a working group of pediatric rheumatologists, ophthalmologists with expertise in the management of uveitis, and parent/patient input, taking into consideration cost, equity, and access.
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