APLAR consensus on the management of JIA
Revised CPG statements for voting
This survey assesses the level of agreement among the consensus panel members group on the remaining recommendations. These recommendations were drafted based on current literature.
You will indicate your level of agreement with each recommendation using a simple yes or no format. A recommendation will be accepted if at least 80% of the total voting members agree with it.
The following recommendation statements apply to monitoring disease activity in children and adolescents with polyarticular course JIA
Statement 17
Original: In patients with positive rheumatoid factor/anti-citrullinated protein antibodies, we recommend performing X-ray of the wrists, hands, forefeet and other symptomatic joints at diagnosis, one year after disease onset and when transiting from pediatric to adult healthcare.
1st Revised: In patients with positive rheumatoid factor/anti-citrullinated protein antibodies or negative rheumatoid factor/anti-citrullinated protein antibodies with adverse prognostic factors*, we recommend performing routine X-ray of the wrists, hands, forefeet and other affected joints** at diagnosis, one year after disease onset and when transiting from pediatric to adult healthcare. *Adverse prognostic factors include early involvement of wrists; distal involvement; symmetrical arthritis, elevated ESR/CRP or bone erosions on previous radiographs. **Affected joints: Joints with active arthritis, limited range of motion or deformities.
Further revision for vote: In patients who test positive for rheumatoid factor/anti-citrullinated protein antibodies, or who exhibit adverse prognostic factors* regardless of antibody status, we suggest performing routine X-rays of the wrists, hands, forefeet, and other affected joints** at the time of diagnosis, one year after disease onset, and during the transition from paediatric to adult healthcare. The decision to use X-rays during follow-up is at the discretion of the treating physician. *Adverse prognostic factors include early involvement of the wrists, distal joint involvement, symmetrical arthritis, elevated ESR/CRP levels, or the presence of bone erosions on previous radiographs. **Affected joints are those with active arthritis, a limited range of motion, or deformities.