A Scoping Review of Approaches to Treat Juvenile Idiopathic Arthritis Symptoms to Inform the Expanded Version of the JIA Option Map
Bibliographic record
Abstract
Objectives Young people with juvenile idiopathic arthritis (JIA) experience physical and psychological symptoms that negatively impact functional activities. Our team previously developed the JIA Option Map, a web-based patient decision aid to support decision-making for JIA pain management. Qualitative work identified a need to expand the JIA Option Map to include ways to manage symptoms beyond pain, such as fatigue, stiffness and mental health symptoms (eg, stress and anxiety), and provide tips to participate in meaningful activities. To inform the expansion of the JIA Option Map, we summarized the evidence for approaches to manage JIA symptoms. Methods We conducted a scoping review following the Arksey and O’Malley framework. We assembled a research team comprised of people with lived experience, health care providers and researchers, and searched major databases for clinical practice guidelines (CPGs) which included systematic reviews (SRs), SRs and randomized controlled trials (RCTs) of approaches for arthritis-symptom treatment other than approaches aimed primarily at reducing disease activity such as disease-modifying antirheumatic drugs. We included approaches that can be used in addition to arthritis treatment to manage pain, stiffness, fatigue and mental health in JIA compared to any control group from database inception to September 2024. We extracted study information including effectiveness and safety of approaches. We assessed the methodological quality of the studies using the Appraisal of guidelines for research and evaluation II (AGREE II), Assessing the methodological quality of systematic reviews 2 (AMSTAR 2) and the Cochrane Risk of Bias 2.0, as well as the strength of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results We included a total of 5 CPGs, 9 SRs and 43 RCTs. We found evidence for splints and orthoses, massage, low-energy laser therapy, various physical activity interventions such as therapeutic exercises and pilates, educational programs and self-management interventions using cognitive behavioral therapy, as well as non-steroidal anti-inflammatory drugs (NSAIDs). Both pharmacological and non-pharmacological approaches were effective although most studies were of low or moderate quality. Conclusion This scoping review shows that a wide variety of approaches are effective in improving JIA symptoms although there is a need for more high-quality studies. Efforts are underway to present this evidence to young people with JIA and parents/caregivers, HCPs and researchers to agree on the information to add to the expanded JIA Option Map. Supported by a CIORA grant
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.061 | 0.217 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.007 | 0.011 |
| Bibliometrics | 0.033 | 0.026 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.007 | 0.008 |
| Open science | 0.003 | 0.005 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".