Pediatric Society of the African League Against Rheumatism juvenile idiopathic arthritis recommendations for enthesitis-related arthritis and juvenile psoriatic arthritis

Wafa Hamdi¹, Angela Migowa², Hanene Lassoued Ferjani³, Chafia Dahou Makhloufi⁴, Yasmine Makhlouf⁵, Samah Ismail Nasef⁶, Nelly Ziade⁷, Xenophone Baraliakos⁸, Hermine Brunner⁹, Mohammed Hassan¹⁰, Temesgen Libe¹¹, Elisa Palalane¹², Waleed Hassan¹³, Ali Sobh¹⁴, Ahmed Seri^{15

16}, Doaa Mosad¹⁷, Hanna Lishan¹⁸, Yassmin Taha¹⁹, Ourida Gacem²⁰, Soad Hashed²¹, Francis Fredrick Furia²², Samy Slimani²³, Christiaan Scott^{24

25}, Djohra Hadef²⁶

Affiliations

¹ Department of Rheumatology, Faculty of Medicine of Tunis, Kassab Institute, Tunis El Manar University, UR17SP04, Tunis, Tunisia. wafahamdi6@yahoo.fr.
² Department of Pediatrics, Aga Khan University Medical College East Africa, Nairobi, P.O. Box 30270, Nairobi, 00100, Kenya.
³ Department of Rheumatology, Faculty of Medicine of Tunis, Kassab Institute, Tunis El Manar University, UR17SP04, Tunis, Tunisia.
⁴ Department of Rheumatology, Faculty of Medicine of Algiers, Med Lamine Debaghine University Hospital, Bab El Oued, BD Said Touati, Algiers, Algeria.
⁵ Department of Rheumatology, Tunis El Manar University Faculty of Medicine of Tunis, Mongi Slim Hospital, Tunis, Tunisia.
⁶ Department of Rheumatology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
⁷ Rheumatology Department, Saint Joseph University and Hotel-Dieu De France, Beirut, Lebanon.
⁸ Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Bochum, Germany.
⁹ Division of Rheumatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
¹⁰ Rheumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
¹¹ College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
¹² Hospital Central de Maputo, Maputo, Mozambique.
¹³ Rheumatology and Rehabilitation Department, Benha University, Banha, Egypt.
¹⁴ Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University Faculty of Medicine, Mansoura, Egypt.
¹⁵ Clinical Immunology and Allergy Center, Royal Care International Hospital, Khartoum, Sudan.
¹⁶ Clinical Immunology and Allergy Department, Soba University Hospital, Al Khurtum, Sudan.
¹⁷ Department of Rheumatology and Rehabilitation, Mansoura University Hospitals, Mansoura University Faculty of Medicine, Mansoura, Egypt.
¹⁸ Rheumatology Unit, Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
¹⁹ Pediatric Rheumatology Unit, Ahmed Gasim Children Hospital, Khartoum, Sudan.
²⁰ Algiers Faculty of Medicine, Department of Pediatrics, El Biar Hospital Algiers, Algiers, Algeria.
²¹ Tripoli Children's Hospital, University of Tripoli, Tripoli, Libya.
²² School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
²³ Atlas Clinic of Rheumatology, Batna, Algeria.
²⁴ Pediatric Rheumatology, University of Ottawa, Ottawa, Ontario, Canada.
²⁵ University of Cape Town, Cape Town, South Africa.
²⁶ Department of Pediatrics, University Hospital Center of Batna Faculty of Medicine, Batna 2 University, Batna, Algeria.

PMID: 39893309
DOI: 10.1007/s10067-025-07334-x

Review

Pediatric Society of the African League Against Rheumatism juvenile idiopathic arthritis recommendations for enthesitis-related arthritis and juvenile psoriatic arthritis

Wafa Hamdi et al. Clin Rheumatol. 2025 Mar.

. 2025 Mar;44(3):901-922.

doi: 10.1007/s10067-025-07334-x. Epub 2025 Feb 1.

Authors

Affiliations

¹ Department of Rheumatology, Faculty of Medicine of Tunis, Kassab Institute, Tunis El Manar University, UR17SP04, Tunis, Tunisia. wafahamdi6@yahoo.fr.
² Department of Pediatrics, Aga Khan University Medical College East Africa, Nairobi, P.O. Box 30270, Nairobi, 00100, Kenya.
³ Department of Rheumatology, Faculty of Medicine of Tunis, Kassab Institute, Tunis El Manar University, UR17SP04, Tunis, Tunisia.
⁴ Department of Rheumatology, Faculty of Medicine of Algiers, Med Lamine Debaghine University Hospital, Bab El Oued, BD Said Touati, Algiers, Algeria.
⁵ Department of Rheumatology, Tunis El Manar University Faculty of Medicine of Tunis, Mongi Slim Hospital, Tunis, Tunisia.
⁶ Department of Rheumatology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
⁷ Rheumatology Department, Saint Joseph University and Hotel-Dieu De France, Beirut, Lebanon.
⁸ Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Bochum, Germany.
⁹ Division of Rheumatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
¹⁰ Rheumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
¹¹ College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
¹² Hospital Central de Maputo, Maputo, Mozambique.
¹³ Rheumatology and Rehabilitation Department, Benha University, Banha, Egypt.
¹⁴ Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University Faculty of Medicine, Mansoura, Egypt.
¹⁵ Clinical Immunology and Allergy Center, Royal Care International Hospital, Khartoum, Sudan.
¹⁶ Clinical Immunology and Allergy Department, Soba University Hospital, Al Khurtum, Sudan.
¹⁷ Department of Rheumatology and Rehabilitation, Mansoura University Hospitals, Mansoura University Faculty of Medicine, Mansoura, Egypt.
¹⁸ Rheumatology Unit, Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
¹⁹ Pediatric Rheumatology Unit, Ahmed Gasim Children Hospital, Khartoum, Sudan.
²⁰ Algiers Faculty of Medicine, Department of Pediatrics, El Biar Hospital Algiers, Algiers, Algeria.
²¹ Tripoli Children's Hospital, University of Tripoli, Tripoli, Libya.
²² School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
²³ Atlas Clinic of Rheumatology, Batna, Algeria.
²⁴ Pediatric Rheumatology, University of Ottawa, Ottawa, Ontario, Canada.
²⁵ University of Cape Town, Cape Town, South Africa.
²⁶ Department of Pediatrics, University Hospital Center of Batna Faculty of Medicine, Batna 2 University, Batna, Algeria.

PMID: 39893309
DOI: 10.1007/s10067-025-07334-x

Abstract

The objective of this study is to develop evidence-based recommendations for the diagnosis and management of enthesitis-related arthritis (ERA) and juvenile psoriatic arthritis (JPsA) in the African context. The recommendations for ERA and JPsA were combined into a single document. The steering committee and task force identified 15 key questions and formulated 35 research questions. A comprehensive literature review, utilizing Medline and a manual search for African local data, was conducted to gather evidence. Following this synthesis, the task force developed draft recommendations and engaged in a Delphi process with an expert panel, including 17 African and three international experts, to reach a consensus and ensure alignment with global standards. The final recommendations were assigned a level of evidence and subsequently approved by the task force members, the expert panel, and the PAFLAR Board. Fifteen recommendations on the diagnosis and management of ERA and JPsA were developed, covering the role of the pediatric rheumatologist in multiple aspects of disease management, including diagnosis, monitoring of disease and extra-articular manifestations, determining treatment strategies, and guiding interventions. The level of evidence supporting these recommendations was variable, leading to the identification of a research agenda to address African particularities and answer pending questions. The final recommendations achieved a high level of agreement, with consensus ranging from 90 to 100%. These recommendations represent an important achievement for pediatric rheumatology in Africa, being the first of their kind, tailored specifically to the region. Developed through a rigorous methodology and collaboration between international and African experts, they aim to standardize care and address the unique challenges faced in African setting.

Keywords: Africa; Enthesitis-related arthritis; Juvenile idiopathic arthritis; Juvenile psoriatic arthritis; PAFLAR; Recommendations.

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Conflict of interest statement

Compliance with ethical standards. Conflict of interest: Xenophone Baraliakos’ COI are Research Grants, Consultant, Scientific Advisory Board: Abbvie, Alphasigma, Amgen, BMS, Cesas, Celltrion, Galapagos, Janssen, Lilly, Moonlake, Novartis, Pfizer, Roche, Sandoz, Springer, Stada, Takeda, UCB, Zuellig. Non-commercial disclosures: ASAS President, EULAR President-Elect, VRA Board Member. Other authors declare no conflict of interest related to the manuscript or the preparation of the guidelines.

References

1. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J et al (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31(2):390–2
1. Martini A, Ravelli A, Avcin T, Beresford MW, Burgos-Vargas R, Cuttica R et al (2019) Toward New classification criteria for juvenile idiopathic arthritis: first steps, pediatric rheumatology international trials organization international consensus. J Rheumatol 46(2):190–197
1. Rumsey DG, Guzman J, Rosenberg AM, Huber AM, Scuccimarri R, Shiff NJ et al (2020) Worse quality of life, function, and pain in children with enthesitis, irrespective of their juvenile arthritis category. Arthritis Care Res (Hoboken) 72(3):441–6
1. Tiendrébéogo JWS, Kaboré F, Sougué C, Sankara V, Zongo E, Savadogo B et al (2023) Epidemiology of rheumatic diseases: a cohort of 23,550 patients in rheumatology clinics in Burkina Faso. Clin Rheumatol 42(2):371–376. https://doi.org/10.1007/s10067-022-06470-y - DOI
1. Akpabio AA, Olaosebikan BH, Adelowo OO (2018) Psoriatic arthritis in Nigeria: case series and literature review. J Clin Rheumatol 24(4):183–187. https://doi.org/10.1097/RHU.0000000000000677 - DOI

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Pediatric Society of the African League Against Rheumatism juvenile idiopathic arthritis recommendations for enthesitis-related arthritis and juvenile psoriatic arthritis

Affiliations

Pediatric Society of the African League Against Rheumatism juvenile idiopathic arthritis recommendations for enthesitis-related arthritis and juvenile psoriatic arthritis

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical