emphasize:
toxicity by pharmacologic agent
children with juvenile idiopathic arthritis ( JIA)
with the patient/caregiver
Strength of Recommendations
confidence in the effect estimate. New data
thought unlikely to change the effect.
confidence that the true effect is likely to be close
be substantially different.
limited confidence about the effect. e true effect
different from the estimate.
little certainty about the effect. e true
different from the estimate.
high-quality evidence (e.g., multiple
trials). Recommended course of action would
patients. Only a small proportion of clinicians/
follow the recommendation. In rare instances,
may be based on very low- to low-certainty
intervention may be strongly recommended if
low-cost, without harms, and the consequence of
intervention may be catastrophic. An intervention
recommended against if there is high certainty of more
with very low or low certainty about its
lower-quality evidence or a close balance between
outcomes. Recommended course of action
majority of the patients, but the alternative is
consideration. Conditional recommendations always
decision-making approach.
question did not support a graded
not favor one intervention over the other;
provided by the voting panel.
Treatment
Table 2. Non-Pharmacologic Therapies
Recommendations Certainty of Evidence
A discussion of healthy, age-appropriate diet is strongly
recommended.
Very low
Use of a specific diet to treat JIA is strongly recommended
against.
Very low
Use of supplemental or herbal interventions specifically to treat
JIA is conditionally recommended against.
Very low
Physical and occupational therapy (PT/OT) are conditionally
recommended regardless of concomitant pharmacologic therapy.
Very low
Table 3. Medication Monitoring
Recommendations Certainty of Evidence
Non-steroidal anti-inflammatory drugs (NSAIDS): Monitoring
via CBC counts, LFTs, and renal function tests every 6–12 months
is conditionally recommended.
Very low
Methotrexate: Monitoring via CBC counts, LFTs, and renal
function tests within the first 1–2 months of usage and every 3–4
months thereaer is strongly recommended.
Very low
Decreasing the methotrexate dosage or withholding methotrexate
is conditionally recommended if a clinically relevant elevation in
LFTs or decreased neutrophil or platelet count is found.
Very low
Use of folic/folinic acid in conjunction with methotrexate is
strongly recommended in conjunction with methotrexate.
Very low
Sulfasalazine: Monitoring via CBC counts, LFTs, and renal
function tests within the first 1–2 months of usage and every 3–4
months thereaer is conditionally recommended.
Very low
Decreasing the sulfasalazine dosage or withholding sulfasalazine
is conditionally recommended if a clinically relevant elevation in
LFTs or decreased neutrophil or platelet count is found.
Very low
Lef lunomide: Monitoring via CBC counts and LFTs within the
first 1–2 months of usage and every 3–4 months thereaer is
conditionally recommended.
Very low
Altering leflunomide administration is conditionally
recommended if a clinically relevant elevation in LFT results
occurs (temporary hold of leflunomide for alanine transaminase
(ALT) >3× the upper limit of normal [ULN]), as per package
insert.
Very low
