The American College of Rheumatology releases two updated guidelines for treatment of juvenile idiopathic arthritis (Don’t use steroids or NSAIDs — use DMARDs)

Medical Xpress / American College of Rheumatology ^ | Mar. 3, 2022 | Karen Onel, MD et al

[ConservativeMind]

The American College of Rheumatology (ACR) released two updated guideline papers for the treatment and management of Juvenile Idiopathic Arthritis (JIA). These two guidelines are companions to previously updated JIA guidelines released by the ACR and Arthritis Foundation in 2019 covering the treatment of polyarthritis, sacroiliitis, uveitis and enthesitis.

The original JIA guidelines were published in 2011 and 2013, and this update reflects the ever-changing rheumatology field with new criteria on how to define disease and new medications to treat those diseases.

"As rheumatologists, our patients and caregivers expect us to review the literature and weigh the evidence so that we can suggest the best treatments, while also considering their preferences," said Karen Onel, MD. "The field has changed tremendously since the 2011 and 2013 efforts, so we needed to adapt our guidance to the times in order to offer our patients the most nimble and state-of-the-art care possible."

One example of where the guideline team has adapted is in their recommendations for using disease-modifying antirheumatic drugs (DMARDs). The guideline on the pharmacologic management of JIA emphasizes early use of conventional synthetic and biologic disease-modifying antirheumatic drugs. This is a much different treatment approach than what was previously recommended.

"For many years, treatment of JIA consisted of corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, bracing and surgery. There were no DMARDs and even if there were, they were not tested or used in children," said Dr. Onel. "These guidelines stress the early use of conventional synthetic and biologic DMARDs and the avoidance of glucocorticoids and NSAIDs. In fact, for systemic JIA the guidelines suggest using biologic DMARDs as a first line. We have turned the pyramid upside down."

[ConservativeMind]

There are two forms of DMARDs, biologic and synthetic.

Some DMARDs are available using mRNAs, so be aware of this, if mRNA use is a concern.

[ConservativeMind]

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[the OlLine Rebel]

Another example of how we often don’t have to “listen to the science”….because the science is always changing.

Biology is especially prone to this. Science is based on how much things have been studied. It’s hard to get a good grip on what happens in biology.

[telescope115]

These diseases are not unlike what my daughter had when she was 3-4 yrs old, Juvenile Dermatomyositis, or JDMS for short. An autoimmune disease in which her immune system was attacking her muscles and joints. It can be life-threatening, it can attack the muscles that we use to breathe, to swallow, even the Heart muscle. Steroids, both IV and orally helped her to put it into remission, along with physical therapy and LOTS of prayers.
She is getting married next month, Praise The Lord, to a wonderful man. I shall be PROUDLY walking her down the aisle.
I’m wondering if her treatment might’ve been different if these options were available back in 1994.

[Myrddin]

800 mg ibuprofen daily for the last 30 years has kept my RA at bay. The gastroenterologist directed me to stop ibuprofen 2 weeks ahead of a colonoscopy and two weeks after because polyps had been excised. Taking a month off was excruciating and much damage occurred. To add insult to injury, one of the excised polyp sites was over a blood vessel. The "scab" ripped off causing a critical hemorrhage. I spent a long night drinking 4 liters of "GoLytely" and pooping large amounts of blood. I was typed and cross matched for a transfusion (fortunately not needed). The emergency colonoscopy fixed the problem. Suffice to say, I have not returned for a replay. The damage done by being forced off ibuprofen exceeds any value from a colonoscopy...especially after the last one.

[ConservativeMind]

You might want to look into DMARDs, now.

I am glad you have had the success you've had with ibuprofen, though. That's pretty remarkable.

I take it you've shifted your eating towards reducing inflammation, right? Also, there are some supplements which can curb RA a bit, as well.

[Myrddin]

I have a long list of daily supplements that keep inflammation down. Some people have the option of immunosuppressive approaches for RA. I have coccidiomycosis (Valley Fever) in remission in my lungs. Immunosuppressive treatments would allow that to go active, so not an option. After the debacle with the COVID-19 mRNA injections, I have zero faith in that technology. Ibuprofen is cheap and effective.

Anecdotal observation: I had a bruise on my shin for over a year. Upon adding PQQ and NAC to my routine, the bruise cleared within 3 weeks. When my tendons become terribly inflamed, adding molecularly distilled fish oil with enhanced DHA/EPA usually calms it down inside of a week.

[joe fonebone]

Be very careful... I was using biologics for psoriatic arthritis. One, enbrel, was fantastic, worked great. Then I was switched to another one, humara, and I started throwing blood clots. Had a stroke and a pe.

If the name ends in mab or mub, be careful.

[ConservativeMind]

May I ask how you know the Valley Fever is only “in remission?” I understand some can have it in remission and need to keep their immune system strong, but many do evict the last bit of it out of their bodies.

How does one know which they are?

[Myrddin]

Coccidiomycosis presents as round, punched out lesions on an x-ray. TB appears amorphous. My Valley Fever test wraps around my arm. The TB test reddens and fades. The Valley Fever is just walled off in a calcium shell. A calcium deficiency could strip the calcium and initiate an active infection. The definition of remission is inexact here.

[ConservativeMind]

I take it that you’ve exhausted the antifungal options?

[Myrddin]

It was walled off when detected in Sept 1976. Nothing to treat. I did have a course of Lamisil that cleared toe nail fungus, but it came back. The doctor was concerned about kidney damage from long term Lamasil. There was never any attempt by my doctor(s) to treat the Valley Fever.

[logi_cal869]

Are you on any medications for diabetes?

[Myrddin]

Not diabetic. No need.