Journal: La Revue de médecine interne
First author: Pierre Quartier
Country of study: France
CEREMAIA Tenon author: Sophie Georgin-Lavialle
Reference: Quartier P, Belot A, Breton S, Carbasse A, Devauchelle V, Fautrel B, Georgin-Lavialle S, Jurquet A-L, Koné-Paut I, Lemelle I, Meinzer U, Melki I, Pillet P, Reumaux H, Rossi-Semerano L, Uettwiller F, and collaborators. French protocol for the diagnosis and management of juvenile idiopathic arthritis including pediatric-onset Still’s disease / Protocole national de diagnostic et de soins pour l’arthrite juvénile. La Revue de médecine interne. 2025;46:449–481.
DOI: https://doi.org/10.1016/j.revmed.2025.06.001
5 key points:
Juvenile idiopathic arthritis starts before the age of 16 and causes joint inflammation lasting at least 6 weeks without another identified cause.
Early diagnosis by a paediatric rheumatologist is essential to reduce pain, joint complications and unnecessary investigations.
Some forms require regular screening for uveitis, an eye inflammation that may be silent but potentially serious.
Care aims for inactive disease or remission through tailored treatments that are regularly reassessed.
The systemic form, also called pediatric-onset Still’s disease, can be severe and requires rapid care in an expert centre.
Introduction:
Juvenile idiopathic arthritis, or JIA, is the main chronic inflammatory rheumatic disease in children. It starts before the age of 16 and causes one or more swollen, painful or stiff joints, especially in the morning or at night. In France, around 5,000 children under 16 are thought to be affected.
Methods:
This article is a French national protocol for diagnosis and care. It brings together updated French recommendations to help healthcare professionals diagnose, treat and follow children with JIA, including the systemic form known as pediatric-onset Still’s disease.
Results:
JIA includes several forms: oligoarthritis, polyarthritis, enthesitis-related forms, psoriasis-associated forms, undifferentiated forms and systemic disease. Diagnosis is based on clinical examination, symptom duration, blood tests, imaging when needed, and exclusion of other causes such as infection. Children also need eye follow-up, because some forms can cause uveitis, an eye inflammation that may have no visible symptoms. Treatments include anti-inflammatory drugs, joint injections, methotrexate, biologic therapies and, in some cases, JAK inhibitors. For pediatric Still’s disease, treatments targeting interleukin-1 or interleukin-6 may be used early.
Discussion:
The article emphasizes a “treat-to-target” strategy, meaning treatment is guided by a clear goal: quickly control inflammation, prevent long-term damage and, if possible, achieve inactive disease or remission. Care must be multidisciplinary, involving a paediatric rheumatologist, general practitioner, ophthalmologist, physiotherapist, occupational therapist, psychologist, nurse, school and family. Therapeutic education helps children and parents understand the disease, recognize flares, manage treatments and maintain life as normally as possible.
Conclusion:
JIA requires early diagnosis, regular follow-up and strong coordination between families and expert teams. Advances in treatment now make it possible to better control inflammation, reduce complications and improve children’s quality of life.