Pan American League of Associations for Rheumatology: Recommendations for the Treatment of Oligoarticular Juvenile Idiopathic Arthritis

Morel Z.; Espada G.; Eraso R.; Silva C.A.; Gutiérrez-Suárez R.; Franco L.; Barzola M.L.; Cameto Caffa J.A.; Faugier-Fuentes E.; Zuccardi P.G.; Herrera C.N.; Ibañez E. A.; Jiménez Cruz K.V.; Jurado R.M.; León B.H.; Rodrigues Fonseca A.; Tineo Rodríguez C.M.; Arroyo Rivera I.L.; Cuttica R.J.; Talesnik E.; Ringer A.; Ramírez Stieben L.A.; Brun L.R.; Marín Zúcaro N.M.; Fernández-Ávila D.G.; Brance M.L.; Appenzeller S.; Ferrándiz M.A. · Journal of Clinical Rheumatology (2026) · DOI: 10.1097/rhu.0000000000002316

Resumen

Objective: – To develop evidence-based Pan American League of Associations for Rheumatology (PANLAR) recommendations for the treatment of oligoarthritis category in juvenile idiopathic arthritis (oligo-JIA) patients. Methods: – A panel of pediatric rheumatologists from Latin-America (LATAM) generated clinically meaningful questions related to the treatment of oligo-JIA patients, using Population, Intervention, Comparator, and Outcome (PICO) format. Following Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, a team of methodologists conducted a systematic literature review, extracted, summarized intervention effect estimates, and graded the evidence quality. LATAM pediatric rheumatology experts’ panel voted each PICO question, which required a minimum agreement of 70% among the voting members and developed recommendations. Results: – Seven recommendations and 4 expert opinion were developed. Short-term course of NSAID and intra-articular corticosteroids was recommended as initial therapy in those with minimal disease activity with no risk factors for poor prognosis. The initiation of a nbDMARD was recommended in patients with high disease activity and risk factors for poor prognosis. For patients who achieve inactive disease state, treatment with DMARD should be maintained for a minimum of 12 months after remission. We proposed sulfasalazine or leflunomide in patients with methotrexate intolerance, or in the presence of contraindication or unavailability of bDMARD. For oligo-JIA patients with high disease activity or uveitis, anti-TNF agents are recommended as the first choice among bDMARD. Regular physical activity was also recommended for these patients. Conclusions: – The first PANLAR oligo-JIA treatment guidelines provide evidence-based guidance for health care providers, treating patients with oligo-JIA in LATAM.