Karen Onel, MD, on Why the New JIA Guideline Is Needed

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The American College of Rheumatology (ACR) guideline for the management of juvenile idiopathic arthritis (JIA) is currently under review and will soon be published. The new recommendations address pharmacologic and nonpharmacologic treatments and are the culmination of a 2-part update of the ACR’s JIA guidelines published in 2011 and 2013. In this video, Karen Onel, MD, explains why these most recent recommendations are needed as well as what new areas they address that had not been included in past guidelines.

Additional Resource:

  • One K. Presentation of the new JIA guidelines. Preview presented at: American College of Rheumatology Convergence 2020; November 5-9, 2020; Virtual. 

Karen Onel, MD, is chief of Pediatric Rheumatology at Hospital for Special Surgery and a professor of Clinical Pediatrics at Weill Cornell Medical School. 


The American College of Rheumatology has a commitment to update recommendations for the treatment of many rheumatic diseases at a specific time frame. The last recommendations for the treatment of childhood arthritis were written in 2011 and then updated in 2013 with a focus on the treatment of kids with systemic juvenile arthritis.

There have been dramatic changes over the time period since that time. The ACR started a project to revamp all of these recommendations.

The first group started and presented their data in 2019. The volume of data that has come out in the last 10 years necessitated that the initial manuscript, the initial set of recommendations were split into two, one for uveitis and the second for enthesitis, sacroiliitis, and polyarthritis.

At that point, the decision was made to defer other recommendations to a second set of guidelines, which are the ones that were presented. It was intended that we would address all of the types of juvenile arthritis and the other issues of great importance to children with arthritis that were not addressed in those original set of recommendations.

Therefore, this set of recommendations specifically discusses oligoarthritis, TMJ arthritis, systemic arthritis, as well as medication monitoring, infection screening, nonpharmacologic therapies and immunizations.

We hope that we have covered the lion’s share of the recommendations that need to be made for children with arthritis. Hopefully, now we will be in the position to ongoingly improve these recommendations as more evidence comes forth over the next several years.