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Management of Polyarticular Course Juvenile Idiopathic Arthritis and Temporomandibular Joint Arthritis: A Systematic
Kai Liang Teh1, Mariel B Valmonte2, Taqdees Khaliq3
1Rheumatology and Immunology Service, KK Women's and Children's Hospital, Singapore, Singapore.
Insights
This systematic review provides evidence for managing juvenile idiopathic arthritis (JIA) in the Asia Pacific. It highlights methotrexate and biologics as effective treatments, with emerging support for JAK inhibitors and biosimilars.
Area of Science:
- Rheumatology
- Pediatric Rheumatology
- Systematic Review & Meta-Analysis
Background:
- Juvenile idiopathic arthritis (JIA) is a common chronic rheumatic disease requiring targeted management to prevent long-term disability.
- Existing Western guidelines may not fully address Asia Pacific-specific factors like genetic variations and healthcare infrastructure.
- This study focuses on polyarticular course JIA (pcJIA) and temporomandibular joint (TMJ) arthritis management.
Purpose of the Study:
- To conduct a systematic literature review (SLR) and meta-analysis to inform the Asia Pacific League of Associations for Rheumatology (APLAR) recommendations.
- To provide up-to-date evidence for managing pcJIA and TMJ arthritis within the Asia Pacific region.
- To identify region-specific treatment strategies and evidence gaps.
Main Methods:
- Systematic review adhering to PRISMA guidelines, searching multiple databases (MEDLINE, Embase, Web of Science, Scopus, CENTRAL) through January 2025.
- Inclusion of studies on pharmacologic and non-pharmacologic treatments for pcJIA and TMJ involvement, excluding those in existing guidelines.
- Quality and evidence certainty assessed using Cochrane Rob2 tool and GRADE approach; meta-analyses performed where applicable.
Main Results:
- Methotrexate remains a cornerstone csDMARD, with subcutaneous administration potentially offering advantages.
- Biological DMARDs (abatacept, tocilizumab) demonstrate good efficacy and safety; JAK inhibitors show emerging promise.
- Biosimilars exhibited comparable efficacy and safety to originators in observational studies; limited evidence supports gradual medication tapering to reduce flares.
Conclusions:
- The SLR provides crucial evidence for region-specific JIA clinical practice, supporting many global recommendations.
- Significant evidence gaps persist in medication tapering, biosimilar utilization, TMJ management, and non-pharmacological therapies.
- Findings will directly contribute to APLAR's forthcoming clinical practice guidelines for pcJIA and TMJ arthritis.
Introduction:
Juvenile idiopathic arthritis (JIA) is one of the most common chronic rheumatic diseases and requires coordinated and targeted treatment strategies to avoid long-term disability. Existing guidelines from Western countries may not address region-specific factors, including genetic heterogeneity, limited treatment availability, and limitations in healthcare infrastructure, in the Asia Pacific region. The aim of this systematic literature review (SLR) and meta-analysis was to provide up-to-date evidence for the Asia Pacific League of Associations for Rheumatology (APLAR) recommendations for managing polyarticular course JIA (pcJIA) and temporomandibular joint (TMJ) arthritis.
Methods:
This systematic review followed PRISMA guidelines, with searches conducted on MEDLINE, Embase, Web of Science, Scopus, and CENTRAL through January 2025. Included studies addressed pharmacologic or non-pharmacologic treatments for pcJIA and TMJ involvement. Studies were limited to publications not already covered in existing guidelines. The Cochrane Rob2 tool and GRADE approach were used to assess quality and evidence certainty. Meta-analyses were performed where applicable.
Results:
Of the initial 9424 records, 86 studies were included in the qualitative analysis. Methotrexate remains the csDMARD of choice, and subcutaneous administration may be more advantageous. Biological DMARDs, particularly abatacept and tocilizumab, have evidence for good efficacy and acceptable safety profiles. Emerging evidence supports the use of JAK inhibitors. Biosimilars were reported to have efficacy and safety comparable to those of originator biologics in observational studies. Limited evidence suggests that gradual medication tapering after achieving inactive disease status reduces the risk of flares. Evidence for physiotherapy, occupational therapy, and complementary medicine was of very low certainty due to methodological heterogeneity.
Conclusion:
This SLR offers new evidence to support region-specific clinical practice in JIA. While many findings support global recommendations, important evidence gaps remain, particularly in tapering, biosimilar use, TMJ management, and non-pharmacological therapies. These insights will directly inform APLAR's upcoming clinical practice guideline for pcJIA and TMJ arthritis.
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