Treatment of polyarticular juvenile idiopathic arthritis in Latin America: recommendations from the Pan-American League of Associations for Rheumatology

To develop evidence-based treatment guidelines for non-systemic polyarticular-juvenile idiopathic arthritis (poly-JIA) in Latin America, endorsed by the Pan-American League of Associations for Rheumatology (PANLAR), a panel of paediatric rheumatologists from Latin America formulated clinically relevant questions regarding polyarthritis treatment, using the Population, Intervention, Comparator, and Outcome (PICO) format. Following the Grading of Recommendations Assessment, Development, and Evaluation methodology, a team of methodologists conducted a systematic literature review, extracted and summarised intervention effect estimates, and assessed the quality of evidence. The panel of paediatric rheumatologists voted on each PICO question and formulated recommendations, requiring a consensus of at least 70% amongst the voting members. Eight recommendations and one expert opinion statement were developed. For newly diagnosed poly-JIA or those with minimal disease activity, the use of non-steroidal anti-inflammatory drugs as adjuvant therapy, along with a non-biological disease-modifying antirheumatic drug (nbDMARD) is recommended. For children and young people achieving an inactive disease state, continuation of nbDMARD treatment for at least 12 months post-remission is advised. In cases of methotrexate intolerance, contraindications, limited availability, or non-response, leflunomide could be used as an alternative. For children and young people with high disease activity or poor prognostic factors, the addition of a biological disease-modifying antirheumatic drug (bDMARD) is recommended. Triple therapy with methotrexate, sulfasalazine, and hydroxychloroquine can be considered when bDMARDs are not available. Low-dose, short-term corticosteroid use is also recommended. The first PANLAR poly-JIA treatment guidelines offer evidence-based recommendations to support health-care providers in the management of poly-JIA in Latin America.