Category Archives: Treatment


Remission: What Exactly Does it Mean for JIA?

The goal of pediatric rheumatologists and their patients has always been for children diagnosed with Juvenile Idiopathic Arthritis (JIA) to be as healthy as they can be.  With more medicines that work better today than ever before, doctors and families now have a goal of complete disease control.  A patient can have complete disease control, or remission while on or off of medicines.

In medical terms, complete disease control or remission means clinical inactive disease (CID) and doctors have this list of things to look at when deciding if a patient is in CID:

  • No joints with active arthritis (swelling, pain, joints that are stiff or hard to move)
  • No fever, rash, or other additional symptoms of children with systemic JIA
  • No active uveitis (eye inflammation)
  • Normal lab tests (or if they aren’t normal, there is a clear reason for them—sickness, injury, etc.)
  • Physician Global Assessment (PGA) of zero (PGA is the number a doctor gives to a patient’s disease activity after they examine them for JIA)
  • Morning stiffness that lasts no longer than 15 minutes

Another way to check to see if a patient is in CID is to calculate their Juvenile Arthritis Disease Activity Score (cJADAS).  This score is important because it allows the patient and/or their caregiver to also provide a number that shows how their JIA is doing.  The cJADAS includes three parts:

  • Active joint count (number of joints with active arthritis at the exam)
  • Physician Global Assessment
  • Patient/Parent Global Assessment of the patient’s overall well-being

The patient is given a total score by adding up the three numbers.  Calculating this score together will help tell the doctor and patient how well their disease is doing so they can decide what their goals are for disease activity and if they should make any changes to their medicines.

Read more about JIA remission. Sign up for the Live Yes! Online Community and join the discussion on the JA Families forum to share and learn about remission and Treat to Target.  It’s free!

Learn more about childhood arthritis, educational and social opportunities and other available resources through the Lives Yes! Arthritis Network.


Jennifer E. Weiss, M.D.

PARTNERS Learning Health System Steering Committee


T2T: Treat To Target for Kids With Juvenile Idiopathic Arthritis

What is Treat to Target (T2T)?

Treat to Target is a name for one of the ways we take care of kids who have juvenile idiopathic arthritis (JIA) to get better results. T2T works by making providers, patients, and their care-givers partners in setting goals.   The first step is when everyone on the team talks about treatment goals and personal goals.  When everyone agrees on goals, they can work together to make a plan.  This helps patients feel like they have more control.  The hope is that patients will be more active and happy.  Their disease can get better, the side effects from medicine can get better, and other sicknesses might be avoided or get better.

How is it Different from Usual Care?

Treat to Target is different from what most JIA patients, caregivers, and providers, are used to.  In the past, providers were the ones making all of the decisions and patients mostly followed that plan.  This way of doing things may feel new to JIA patients, but it’s already being used in other medical conditions, such as high blood pressure, diabetes, and adult arthritis – with great results!

What will Happen at My Appointments?

For many patients, inactive disease is the target.  This means that there are no signs and symptoms of JIA (such as swollen joints, pain, or stiffness).  For some patients, inactive disease is harder to reach, so they may set a goal of low disease activity (things like swelling, pain, and stiffness will happen less often and be easier to handle).  In addition to deciding on a treatment target, more personal goals should be set, such as going to school more often, playing sports, or being creative.

When the patient visits the provider or care team, they will talk about how the patient is doing.  They will then choose goals, or “targets”, together.  Everyone on the team has a job while using T2T.  Patients and caregivers must be honest about their needs and wants.  They must also be honest with the provider or team about how well they are following their treatment plan, including taking their medicine.  The care team must be able to listen to the patient about what is important to them.  Together, they will come up with a plan to reach their target, and do their best to stick to the plan.

What Happens Next?

When following T2T, we want most patients to be 50% better within three months and reach their target within six months.  Medical staff will keep track of how well the patient is doing at each appointment.  If it seems like the patient is not “at target,” the team will work together to figure out why and come up with a new plan.  This might mean changing the dose of medicine, how often they take the medicine, or even trying new medicine. If a patient reaches their target, they will talk to their provider about how long they should stay on the plan.  Sometimes patients can take less medicine or stop taking it after they have been at their target for a while.  It’s important to remember that there is no way to know if a patient’s disease will stay inactive or for how long.  If the JIA comes back, the Treat to Target process will start again.  Everyone will keep working hard – together – to make every JIA patient feel as well as they can!

Read more about JIA remission. Sign up for the Live Yes! Online Community and join the discussion on the JA Families forum to share and learn about remission and Treat to Target.  It’s free!

Learn more about childhood arthritis, educational and social opportunities and other available resources through the Lives Yes! Arthritis Network.


©Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN)

Squash Your Risk of Tick- and Mosquito-borne Infections

More than 30,000 cases of Lyme occur each year across the country, the CDC estimates. To the summer hazards of too much sun and heat, add the perils of tiny pests carrying infections, such as Lyme disease and chikungunya, that cause joint pain. 

 The number of people sickened by tick and mosquito-borne diseases in the U.S. has risen to record levels recently, according to the Centers for Disease Control and Prevention (CDC).  Continue reading Squash Your Risk of Tick- and Mosquito-borne Infections

Reminder to diet and exercise on small chalkboard with dumbbell

How Shedding Pounds Eases Arthritis Symptoms

You’ve heard this before, but it bears repeating: One of the best things you can do for arthritis is to lose excess weight. Research shows that while diet and exercise combined are most effective for dropping pounds, dieting alone helps more than exercise alone. No one’s saying it’s easy, but evidence shows it pays off. Here’s how it can help. Continue reading How Shedding Pounds Eases Arthritis Symptoms

when to go to the emergency room

Know When to Go to the Emergency Room

You’re feeling sick but your doctor is booked and the nearest urgent care center is 45 minutes away. There’s always the hospital emergency room, but your symptoms aren’t that bad. Should you just tough it out?

Figuring out how and where to handle an illness isn’t easy. It’s even harder for people with inflammatory types of arthritis, because complications related to the disease and its treatment can be serious, says Uzma Haque, MD, assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore. Here’s what she suggests:

Continue reading Know When to Go to the Emergency Room

integrated medicine for arthritis

Integrative Medicine Approach for Arthritis

Some people with arthritis feel that doctor-patient communication can sometimes seems narrow and impersonal. Integrative medicine aims to be different.

“Patients are at the center of integrated medicine; our goal is to partner with them to address the physical, emotional, social, environmental and spiritual factors that affect health,” says internist Adam Perlman, MD, executive director of Duke Integrative Medicine in Durham, N.C. “This approach is very inclusive. We practice and believe in Western medicine, but we also have an openness to complementary modalities that help address the whole person.”

Continue reading Integrative Medicine Approach for Arthritis

arthritis misdiagnosis

Arthritis Misdiagnosis

For 20 years, Frances Muller’s rheumatoid arthritis (RA) was misdiagnosed. A neurologist told her the pain in her hands was carpal tunnel syndrome. An internist told her the all-over aches were the flu. An orthopaedic surgeon said she had bursitis in both shoulders. “None of my symptoms made any sense,” and none of the treatments helped, says Muller, who lives in Scottsdale, Ariz. After she’d seen 13 other doctors, an orthopaedic surgeon who ordered an X-ray of her pelvis finally figured it out: there was no way she could have so much damage to her hips and not have RA.

Misdiagnosis is one of the most common medical errors, occurring in about 10 to 20 percent of cases, according to the National Center for Policy Analysis. It can lead to unnecessary or delayed treatments and physical and emotional suffering.

In rheumatology, where symptoms and diseases frequently overlap, even experienced and well-intentioned physicians can miss important clues. “For many rheumatic diseases, there’s no gold standard [for diagnosis],” says Don L. Goldenberg, MD, chief of rheumatology at Newton-Wellesley Hospital in Massachusetts. “You don’t biopsy it. There aren’t a lot of laboratory tests.” If patients are concerned, they should get a second opinion, he adds.

Continue reading Arthritis Misdiagnosis

medical imaging arthritis diagnosis

Medical Imaging for Arthritis Diagnosis

Whether it’s magnetic resonance imaging (MRI), an ultrasound or a good old-fashioned X-ray, your doctor is likely to order some type of medical imaging to see what’s going on below the surface with your arthritis.

“The most important thing rheumatologists can do to assess patients is still a good history and clinical exam. The role of imaging is to assist in assessing the degree of severity,” says Orrin Troum, MD, professor of medicine at University of Southern California and spokesperson for the International Society for Musculoskeletal Imaging in Rheumatology. Understanding its severity helps a doctor decide how aggressively to treat the disease.

Continue reading Medical Imaging for Arthritis Diagnosis