The Asia‐Pacific League of Associations for Rheumatology Consensus Recommendations on the Management of Juvenile Idiopathic Arthritis (JIA): Polyarticular Course JIA, Temporomandibular Joint Arthritis, Imaging, and Non‐Pharmacologic Therapies

BACKGROUND: Juvenile idiopathic arthritis (JIA) is one of the most common childhood rheumatic diseases. In the Asia-Pacific region, access to pediatric rheumatology services and therapies remains variable. To address regional disparities and promote evidence-based yet practical care, the APLAR developed consensus recommendations for the management of polyarticular-course JIA (pcJIA), temporomandibular joint (TMJ) arthritis, and non-pharmacologic interventions. METHODS: A multidisciplinary task force of 34 members from 14 countries, including pediatric and adult rheumatologists and patient representatives, was convened. The guideline development followed the GRADE, ADAPTE, and AGREE II frameworks. Existing international guidelines were critically appraised, and a systematic literature review was performed to address 26 PICO questions. Draft statements were discussed and voted upon using a modified Delphi process, with consensus defined as ≥ 80% agreement. RESULTS: Four overarching principles and 32 statements were finalized: 16 for pcJIA treatment, 10 for TMJ arthritis, 3 for non-pharmacologic therapies, 2 for imaging, and 1 for disease monitoring. Key recommendations that diverge from Western guidelines include: (1) stronger recommendation for methotrexate as initial therapy before biologic DMARDs; (2) explicit advocacy for TNF inhibitors, including biosimilars, when escalation is required; (3) cautious allowance of short-term systemic glucocorticoids where DMARDs are limited; (4) emphasis on treat-to-target using cJADAS-10; (5) stronger endorsement for physical and occupational therapy; and (6) conditional allowance of traditional and complementary medicine practices under professional supervision. CONCLUSION: These consensus statements provide regionally adapted, evidence-based recommendations to improve access, standardize management, and promote equitable care for patients with JIA across the Asia-Pacific region.

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Journal
International Journal of Rheumatic Diseases
Published
2026-04-01
DOI
https://doi.org/10.1111/1756-185x.70640
Primary Topic
Autoimmune and Inflammatory Disorders Research
Type
article
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article

The Asia‐Pacific League of Associations for Rheumatology Consensus Recommendations on the Management of Juvenile Idiopathic Arthritis (JIA): Polyarticular Course JIA, Temporomandibular Joint Arthritis, Imaging, and Non‐Pharmacologic Therapies

Narendra Kumar Bagri, Suma Balan, Takako Miyamae, Taqdees Khaliq et al.
International Journal of Rheumatic Diseases
Autoimmune and Inflammatory Disorders Research
article

The Asia‐Pacific League of Associations for Rheumatology Consensus Recommendations on the Management of Juvenile Idiopathic Arthritis (JIA): Polyarticular Course JIA, Temporomandibular Joint Arthritis, Imaging, and Non‐Pharmacologic Therapies

Narendra Kumar Bagri, Suma Balan, Takako Miyamae, Taqdees Khaliq, Vahid Ziaee, Thaschawee Arkachaisri, Butsabong Lerkvaleekul, Priscilla Campbell‐Stokes, Sumaira Farman, Watchareewan Sontichai, Jayathri Jagoda, Rebecca James, Christine B. Bernal, Ma. Theresa M. Collante, Swee Ping Tang, Elizabeth Y. Ang, Sern Chin Lim, Sirirat Charuvanij, Soamarat Vilaiyuk, Carla Marie L Asis, Sulaiman M. Al‐Mayouf, Chao‐Yi Wu, Cherica A. Tee, K. L. Teh, Leonila F. Dans, Junjie Huang, Pauline Chan, Kosar Asnaashari, Marian Crisal M. Celindro‐Chan, Winnie K. Y. Chan, Maria Janina H. Lebrudo, Mariel B. Valmonte, Assunta C. H. Ho, Nathalie Gail U. Choi
article en

Abstract

BACKGROUND: Juvenile idiopathic arthritis (JIA) is one of the most common childhood rheumatic diseases. In the Asia-Pacific region, access to pediatric rheumatology services and therapies remains variable. To address regional disparities and promote evidence-based yet practical care, the APLAR developed consensus recommendations for the management of polyarticular-course JIA (pcJIA), temporomandibular joint (TMJ) arthritis, and non-pharmacologic interventions. METHODS: A multidisciplinary task force of 34 members from 14 countries, including pediatric and adult rheumatologists and patient representatives, was convened. The guideline development followed the GRADE, ADAPTE, and AGREE II frameworks. Existing international guidelines were critically appraised, and a systematic literature review was performed to address 26 PICO questions. Draft statements were discussed and voted upon using a modified Delphi process, with consensus defined as ≥ 80% agreement. RESULTS: Four overarching principles and 32 statements were finalized: 16 for pcJIA treatment, 10 for TMJ arthritis, 3 for non-pharmacologic therapies, 2 for imaging, and 1 for disease monitoring. Key recommendations that diverge from Western guidelines include: (1) stronger recommendation for methotrexate as initial therapy before biologic DMARDs; (2) explicit advocacy for TNF inhibitors, including biosimilars, when escalation is required; (3) cautious allowance of short-term systemic glucocorticoids where DMARDs are limited; (4) emphasis on treat-to-target using cJADAS-10; (5) stronger endorsement for physical and occupational therapy; and (6) conditional allowance of traditional and complementary medicine practices under professional supervision. CONCLUSION: These consensus statements provide regionally adapted, evidence-based recommendations to improve access, standardize management, and promote equitable care for patients with JIA across the Asia-Pacific region.

International Journal of Rheumatic DiseasesVol. 29(4)
Ministry of Health (MY), University of Santo Tomas Hospital (PH), Amrita Institute of Medical Sciences and Research Centre (IN), Siriraj Hospital (TH), Alfaisal University (SA), Chinese University of Hong Kong (HK), Shalamar Hospital (PK), Government of Pakistan (PK), Lady Ridgeway Hospital for Children (LK), Philippine General Hospital (PH), Chang Gung Memorial Hospital (TW), Taoyuan Chang Gung Memorial Hospital (TW), Doctors Hospital (US), KK Women's and Children's Hospital (SG), Children's Medical Center (IR), Prince of Wales Hospital (CN), St. Luke's Medical Center (PH), Capital and Coast District Health Board (NZ), Hospital Selayang (MY), Tokyo Women's Medical University (JP), Hospital Sungai Buloh (MY), Ramathibodi Hospital (TH), National University Health System (SG), Philippine Heart Center (PH), Shaikh Zayed Postgraduate Medical Institute (PK), Department of Education - Division of Bataan (PH), Queen Elizabeth Hospital (CN), Children's Health Queensland Hospital and Health Service (AU), Chiang Mai University (TH), University of the Philippines Manila (PH), All India Institute of Medical Sciences (IN), Tehran University of Medical Sciences (IR), Universiti Teknologi MARA (MY), University of the Philippines Diliman (PH)
Partnerships for the goals
Openalex Percentile: Top 22%
Autoimmune and Inflammatory Disorders Research
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