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Clinical guidelines

Clinical guideline for the diagnosis and management of juvenile idiopathic arthritis

August 2009

In Australia, at least 5000 children are affected by juvenile idiopathic arthritis (JIA) at any one time. Disease prevalence in Australia is between one and four cases per 1000 children. Juvenile idiopathic arthritis can have significant associated morbidity and mortality. Long term follow up studies have revealed JIA carries the potential for longer term inflammatory activity and complications, leaving a lasting impact on the patient’s function, growth and quality of life. Accurate and early diagnosis along with appropriate management and referral are essential for maximising patient outcomes and quality of life.

General practice plays an important role within the Australian health care system in prevention, early detection and chronic disease management (CDM). To manage chronic illness effectively requires well coordinated, patient centred care that is continuous, comprehensive, and consistent. General practitioners are well placed to provide this care and undertake this role in consultation with other medical specialists as required. The role GPs play in CDM through multidisciplinary care coordination and long term care planning is recognised within the national Medicare rebate framework. Children with arthritis are eligible for broader funding arrangements under CDM items for GP Management Plans and associated reviews.

As part of the Australian Federal Government’s Better Arthritis and Osteoporosis Care (BAOC) 2006–2007 budget initiative, guidelines for the management of osteoarthritis, rheumatoid arthritis, and juvenile idiopathic arthritis have been developed to inform evidence based primary care of chronic disease in general practice.

It is important that children presenting with JIA are diagnosed early; have initial management commenced by their GP; and are referred promptly to a paediatric rheumatologist. Because of the relatively low prevalence of JIA in the general population, GPs often develop little experience with the diagnosis or management of JIA. The Clinical guideline for the diagnosis and management of juvenile idiopathic arthritis has been developed to fill that gap.

The guideline presents recommendations to assist GPs managing patients with JIA. It focuses on short term care, long term care planning and management, and coordination of multidisciplinary care needs. The guideline includes algorithms and resources to assist with the implementation of the recommendations.

Expiry date for the recommendations

This guideline presents a comprehensive review of pharmacological and non-pharmacological management of JIA within the Australian health care context, based on the best available evidence up to January 2007. Evidence published after this date has not been reviewed for the guideline.

The guideline was approved by the CEO of the NHMRC on 12 June 2009, under section 14A of the National Health and Medical Research Council Act 1992. Approval for the guidelines by the NHMRC is granted for a period not exceeding 5 years. It is expected that the guideline will be reviewed, and revised if necessary, no less than once every 5 years. Review should be more frequent in areas where clinical practice or research is known to be changing rapidly. Readers should check with the RACGP for any reviews or updates of the guideline.

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