{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:34:32Z","timestamp":1790382872087,"version":"4.1.0"},"reference-count":81,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T00:00:00Z","timestamp":1646092800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000960","name":"ACR","doi-asserted-by":"publisher","award":["91853109"],"award-info":[{"award-number":["91853109"]}],"id":[{"id":"10.13039\/100000960","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["K23-AR-070286"],"award-info":[{"award-number":["K23-AR-070286"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We developed clinically relevant Patient\/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients\/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Recommendations in this guideline include the use of physical therapy and occupational therapy interventions; a healthy, well\u2010balanced, age\u2010appropriate diet; specific laboratory monitoring for medications; widespread use of immunizations; and shared decision\u2010making with patients\/caregivers. Disease management for all patients with JIA is addressed with respect to nonpharmacologic therapies, medication monitoring, immunizations, and imaging. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis, and a concurrent 2021 guideline on oligoarthritis, temporomandibular arthritis, and systemic JIA. It serves as a tool to support clinicians, patients, and caregivers in decision\u2010making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision\u2010making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient\/caregiver.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.42036","type":"journal-article","created":{"date-parts":[[2022,3,2]],"date-time":"2022-03-02T00:01:54Z","timestamp":1646179314000},"page":"570-585","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging"],"prefix":"10.1002","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1238-5361","authenticated-orcid":false,"given":"Karen B.","family":"Onel","sequence":"first","affiliation":[{"name":"Hospital for Special Surgery  New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1831-1339","authenticated-orcid":false,"given":"Daniel B.","family":"Horton","sequence":"additional","affiliation":[{"name":"Rutgers Robert Wood Johnson Medical School  New Brunswick New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1604-0130","authenticated-orcid":false,"given":"Daniel J.","family":"Lovell","sequence":"additional","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center and University of Cincinnati  Cincinnati Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2495-594X","authenticated-orcid":false,"given":"Susan","family":"Shenoi","sequence":"additional","affiliation":[{"name":"Seattle Children's Hospital and Research Center and University of Washington  Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos A.","family":"Cuello","sequence":"additional","affiliation":[{"name":"McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9552-6464","authenticated-orcid":false,"given":"Sheila T.","family":"Angeles\u2010Han","sequence":"additional","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center and University of Cincinnati  Cincinnati Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mara L.","family":"Becker","sequence":"additional","affiliation":[{"name":"Duke University  Durham North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2661-3086","authenticated-orcid":false,"given":"Randy Q.","family":"Cron","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"Feldman","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polly J.","family":"Ferguson","sequence":"additional","affiliation":[{"name":"University of Iowa Carver College of Medicine  Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Gewanter","sequence":"additional","affiliation":[{"name":"Children's Hospital of Richmond at VCU  Richmond Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8977-2581","authenticated-orcid":false,"given":"Jaime","family":"Guzman","sequence":"additional","affiliation":[{"name":"BC Children's Hospital  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7132-3390","authenticated-orcid":false,"given":"Yukiko","family":"Kimura","sequence":"additional","affiliation":[{"name":"Hackensack Meridian School of Medicine  Hackensack New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzielan","family":"Lee","sequence":"additional","affiliation":[{"name":"Stanford University  Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Murphy","sequence":"additional","affiliation":[{"name":"Louisiana Department of Health  New Orleans"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Boston Children's Hospital and Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3322-4089","authenticated-orcid":false,"given":"Michael J.","family":"Ombrello","sequence":"additional","affiliation":[{"name":"NIH  Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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