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

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.