The Challenges and Opportunities of Classifying Childhood Arthritis
Purpose of Review
Childhood arthritis is in need of a new system of classification, owing to deficiencies in the International League of Associations for Rheumatology (ILAR) criteria. We briefly review the history of classification of childhood arthritis, discuss the major criticisms of the current system, and highlight current initiatives to address those concerns.
Recent studies in both pediatric and adult rheumatology into the biologic basis of disease as well as the clinical patterns of presentation have informed the efforts toward developing a new classification system.
Several efforts are currently underway to improve the classification of childhood arthritis, most notably the project of the Pediatric Rheumatology International Trials Organization (PRINTO). This international alliance of pediatric rheumatologists has begun a 4-step process to create new classification criteria for childhood arthritis. They are currently on step 3 of the process.
KeywordsChildhood arthritis Classification JIA ILAR PRINTO
Compliance with Ethical Standards
Conflict of Interest
Dr. Rumsey and Dr. Laxer declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Criteria for the classification of juvenile rheumatoid arthritis. Bull Rheum Dis. 1972;23(5):712–9.Google Scholar
- 3.Brewer EJ Jr, Bass J, Baum J, Cassidy JT, Fink C, Jacobs J, et al. Current proposed revision of JRA Criteria. JRA Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Section of The Arthritis Foundation. Arthritis Rheum. 1977;20(2 Suppl):195–9.PubMedGoogle Scholar
- 4.European League Against Rheumatism. EULAR Bulletin No. 4: Nomenclature and Classification of Arthritis in Children. Basal: National Zeitung AG; 1977.Google Scholar
- 7.Petty RE, Laxer RM, Wedderburn LR. Juvenile idiopathic arthritis. In: Petty RE, Laxer RM, Lindsley CB, Wedderburn LR. Textbook of pediatric rheumatology 2016. p. 1880204.e6.Google Scholar
- 12.• Nigrovic PA, Martinez-Bonet M, Thompson SD. Implications of juvenile idiopathic arthritis genetic risk variants for disease pathogenesis and classification. Curr Opin Rheumatol. 2019;31(5):401–10 A recent paper showing genetic data that indicate a continuity between JIA and adult arthritis that is not adequately reflected in the current classification criteria.CrossRefGoogle Scholar
- 15.Nigrovic PA, Schneider R. Systemic juvenile idiopathic arthritis and adult onset still disease. In: Hashkes PJ, Laxer RM, Simon A, editors. Textbook of Autoinflammation: Springer Nature Switzerland; 2019. p. 587–616.Google Scholar
- 22.Pinto Tasende JA, Maceiras Pan FJ, Mosquera Martinez JA, Fernandez Dominguez L, Correa Rey B, Garcia Porrua C. Secukinumab as biological treatment for psoriatic arthritis in real clinical practice. Reumatol Clin. 2019.Google Scholar
- 30.Prahalad S, Conneely KN, Jiang Y, Sudman M, Wallace CA, Brown MR, et al. Susceptibility to childhood-onset rheumatoid arthritis: investigation of a weighted genetic risk score that integrates cumulative effects of variants at five genetic loci. Arthritis Rheum. 2013;65(6):1663–7.CrossRefGoogle Scholar
- 31.Omar A, Abo-Elyoun I, Hussein H, Nabih M, Atwa H, Gad S, et al. Anti-cyclic citrullinated peptide (anti-CCP) antibody in juvenile idiopathic arthritis (JIA): correlations with disease activity and severity of joint damage (a multicenter trial). Joint Bone Spine. 2013;80(1):38–43.CrossRefGoogle Scholar
- 32.• Nigrovic PA, Raychaudhuri S, Thompson SD. Review: genetics and the classification of arthritis in adults and children. Arthritis Rheumatol. 2018;70(1):7–17 A recent paper that proposes an elimination of divisions in arthritis nomenclature based on arbitrary age cut-offs. This recommendation is backed up by genetic data.CrossRefGoogle Scholar
- 33.•• Martini A, Ravelli A, Avcin T, Beresford MW, Burgos-Vargas R, Cuttica R, et al. Toward new classification criteria for juvenile idiopathic arthritis: first steps, pediatric rheumatology international trials organization international consensus. J Rheumatol. 2019;46(2):190–7 A paper which describes the results of the first two parts of a 4-part international initiative to create new classification criteria for childhood arthritis.CrossRefGoogle Scholar
- 35.Sieper J, van der Heijde D, Landewe R, Brandt J, Burgos-Vagas R, Collantes-Estevez E, et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis. 2009;68(6):784–8.CrossRefGoogle Scholar