Overview of the Treatment Goal, the Method of Evaluating Disease Activity/Physical Function, Activities of Daily Living, and Traditional Care for Systemic or Articular Juvenile Idiopathic Arthritis in Japan

Author:

Mori Masaaki12ORCID

Affiliation:

1. Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan

2. Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan

Abstract

Juvenile idiopathic arthritis (JIA) is a chronic arthritis of unknown cause that develops in patients younger than 16 years of age and persists for at least 6 weeks. It is an important cause of short- and long-term physical and mental impairments in children. The goal of treatment for JIA is remission. A T2T (treatment-to-target) has been proposed and practiced as a means of achieving remission. The method of evaluating the disease activity of JIA depends on the disease type. For systemic JIA, disease activity is determined by comprehensively considering joint findings, systemic inflammatory findings, changes in inflammatory and synovitis markers, imaging findings, and other factors. For articular JIA other than systemic JIA, the Juvenile Arthritis Disease Activity Score (JADAS-27) is used to evaluate disease activity. The CHAQ (Childhood Health Assessment Questionnaire) and the Japanese version of the modified Rankin Scale (mRS) are mainly used to assess the physical function and ADL. The CHAQ is a global standard assessment method with the advantage that it can be transitioned to the HAQ used in adults, making it useful for international comparisons. The mRS is used to classify the severity of JIA as a chronic disease, and is an indispensable evaluation method in the specific disease procedure in Japan. It is necessary to have pediatric-specific knowledge of growth and development and routine childhood immunizations and to consider transition support tailored to the patient’s situation. Ultimately, the goal is to foster the patient’s independence and to provide an uninterrupted follow-up in the adult care department. Continuous follow-up will be provided during the schooling (and later, employment) period, and the relationship with the patient will be tailored to their developmental stage. It is also important to understand and communicate the importance of contraception and the drugs that cannot be used during pregnancy.

Publisher

MDPI AG

Reference19 articles.

1. International League of Associations for Rheumatology: International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: Second revision, Edmonton, 2001;Petty;J. Rheumatol.,2004

2. Subcommittee for Investigation of Pediatric Rheumatoid Arthritis, and Japan College of Rheumatology (2015). Guide to the Initial Treatment of Juvenile Idiopathic Arthritis 2015, Medical Review Co., Ltd.

3. Takei, S. (2022). Childhood Arthritis and Rheumatology Research for Dreams Come True Remission. Children, 9.

4. Subcommittee for Investigation of Pediatric Rheumatoid Arthritis, and Japan College of Rheumatology (2017). Clinical Handbook of Juvenile Idiopathic Arthritis 2017, Medical Review Co., Ltd.

5. (2024, June 21). A Guide for Medical Staff to Support Patients with Rheumatoid Arthritis at Every Stage of Life (Edited by Research Group for “Research on Support for Patients with Rheumatoid Arthritis According to Life Stages”, Project Funded by Grant-in-Aid for Scientific Research on Policy Research on Immunological and Allergic Diseases, MHLW), Japan, 2021. Available online: https://www.ryumachi-jp.com/medical-staff/life-stage-guide/.

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