African guidelines for diagnosis and management of polyarticular juvenile idiopathic arthritis: PAFLAR initiative

Mohammed Hassan Abu-Zaid¹, Angela Nyangore Migowa², Hanna Lishan Kassa³, Wassila Messadi⁴, Yassmine Taha⁵, Yaninga Halwani Fuseini⁶, Madeleine Ngandeu⁷, Yasser El Miedany⁸, Michael Hofer^{9

10}, Wafa Hamdi¹¹, Temesgen Teferi Libe¹², Ali Sobh¹³, Waleed Hassan¹⁴, Yasmine Makhlouf¹⁵, Ayodele Faleye¹⁶, Soad Hashed¹⁷, Samah Ismail Nasef¹⁸, Chafia Dahou Makhloufi¹⁹, Elisa Palalane²⁰, Hanene Lassoued Ferjani²¹, Ahmed Seri²², Doaa Mosad Mosa²³, Ourida Gacem²⁴, Francis Fredrick Furia²⁵, Samy Slimani²⁶, Christiaan Scott²⁷, Djohra Hadef²⁸

Affiliations

¹ Rheumatology and Rehabilitation, Dept. Faculty of Medicine, Tanta University, Tanta, Egypt. mohammed.kamel@med.tanta.edu.eg.
² Department of Paediatrics, Aga Khan University Medical College East, P.O Box 30270, Africa NairobiNairobi, 00100, Kenya.
³ Rheumatology Unit, Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Ethiobia, Ethiopia.
⁴ University Hospital of Issaad Hassani, Messous, Algeria.
⁵ Paediatric Rheumatology Unit, Ahmed Gasim Children Hospital, Khartoum, Sudan.
⁶ Tamale Teaching Hospital, Tamale, Ghana.
⁷ University of Yaounde, Yaounde, Cameroon.
⁸ Canterbury Christ Church University, Canterbury, England.
⁹ Hôpital Riviera-Chablais, Rennaz, Switzerland.
¹⁰ Fondation Rhumatismes-Enfants, Lausanne, Switzerland.
¹¹ Department of Rheumatology Kassab Institute, Ur17sp04 Tunis El Manar University Faculty of Medicine of Tunis, Tunis, Tunisia.
¹² Haramaya University, Dire Dawa, Ethiopia.
¹³ Department of Pediatrics, Faculty of Medicine, Mansoura University Children'S Hospital, Mansoura University, Mansoura, Egypt.
¹⁴ Rheumatology Dept. Faculty of Medicine, Benha University, Benha, Egypt.
¹⁵ Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.
¹⁶ Paediatric Rheumatology Unit, Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
¹⁷ Tripoli Children'S Hospital, University of Tripoli, Tripoli, Libya.
¹⁸ Rheumatology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
¹⁹ Department of Rheumatology, Med Lamine Debaghine University Hospital, BD Said Touati, Bab El OuedAlgiers, Algeria.
²⁰ Faculty of Medicine of Algiers, Algiers, Algeria.
²¹ Hospital Central de Maputo, Maputo, Tunisia.
²² Clinical Immunolgy and Allergy Centre, Royal Care International Hospital / Clinical Immunology and Allergy Department, Soba University Hospital, Khartoum, Sudan.
²³ Department of Rheumatology& Rehabilitation, Mansoura University Hospitals, Mansoura, Egypt.
²⁴ Department of Pediatrics, Birtraria Hospital El Biar, University of Algiers 1, Algiers, Algeria.
²⁵ Department of Paediatrics and Child Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
²⁶ Atlas Clinic of Rheumatology, Batna, Algeria.
²⁷ Pediatric Rheumatology, University of Ottawa, Ottawa Ontario and University of Cape Twon, Cape Town, South Africa.
²⁸ Faculty of Medicine, Batna 2 University, Batna, Algeria.

PMID: 40089767
PMCID: PMC11909873
DOI: 10.1186/s12969-025-01076-5

African guidelines for diagnosis and management of polyarticular juvenile idiopathic arthritis: PAFLAR initiative

Mohammed Hassan Abu-Zaid et al. Pediatr Rheumatol Online J. 2025.

. 2025 Mar 15;23(1):27.

doi: 10.1186/s12969-025-01076-5.

Authors

Affiliations

¹ Rheumatology and Rehabilitation, Dept. Faculty of Medicine, Tanta University, Tanta, Egypt. mohammed.kamel@med.tanta.edu.eg.
² Department of Paediatrics, Aga Khan University Medical College East, P.O Box 30270, Africa NairobiNairobi, 00100, Kenya.
³ Rheumatology Unit, Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Ethiobia, Ethiopia.
⁴ University Hospital of Issaad Hassani, Messous, Algeria.
⁵ Paediatric Rheumatology Unit, Ahmed Gasim Children Hospital, Khartoum, Sudan.
⁶ Tamale Teaching Hospital, Tamale, Ghana.
⁷ University of Yaounde, Yaounde, Cameroon.
⁸ Canterbury Christ Church University, Canterbury, England.
⁹ Hôpital Riviera-Chablais, Rennaz, Switzerland.
¹⁰ Fondation Rhumatismes-Enfants, Lausanne, Switzerland.
¹¹ Department of Rheumatology Kassab Institute, Ur17sp04 Tunis El Manar University Faculty of Medicine of Tunis, Tunis, Tunisia.
¹² Haramaya University, Dire Dawa, Ethiopia.
¹³ Department of Pediatrics, Faculty of Medicine, Mansoura University Children'S Hospital, Mansoura University, Mansoura, Egypt.
¹⁴ Rheumatology Dept. Faculty of Medicine, Benha University, Benha, Egypt.
¹⁵ Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia.
¹⁶ Paediatric Rheumatology Unit, Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
¹⁷ Tripoli Children'S Hospital, University of Tripoli, Tripoli, Libya.
¹⁸ Rheumatology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
¹⁹ Department of Rheumatology, Med Lamine Debaghine University Hospital, BD Said Touati, Bab El OuedAlgiers, Algeria.
²⁰ Faculty of Medicine of Algiers, Algiers, Algeria.
²¹ Hospital Central de Maputo, Maputo, Tunisia.
²² Clinical Immunolgy and Allergy Centre, Royal Care International Hospital / Clinical Immunology and Allergy Department, Soba University Hospital, Khartoum, Sudan.
²³ Department of Rheumatology& Rehabilitation, Mansoura University Hospitals, Mansoura, Egypt.
²⁴ Department of Pediatrics, Birtraria Hospital El Biar, University of Algiers 1, Algiers, Algeria.
²⁵ Department of Paediatrics and Child Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
²⁶ Atlas Clinic of Rheumatology, Batna, Algeria.
²⁷ Pediatric Rheumatology, University of Ottawa, Ottawa Ontario and University of Cape Twon, Cape Town, South Africa.
²⁸ Faculty of Medicine, Batna 2 University, Batna, Algeria.

PMID: 40089767
PMCID: PMC11909873
DOI: 10.1186/s12969-025-01076-5

Abstract

Background: Juvenile idiopathic arthritis (JIA) is the most common rheumatologic disease of childhood. The Existing guidelines for polyarticular JIA are typically based on data from non-African populations and may not fully address the unique challenges faced in African settings. We aimed to produce updated African guidelines for the diagnosis and treatment of children and adolescents with polyarticular juvenile idiopathic arthritis (poly-JIA).

Methods: This study was conducted with the aim of reaching a consensus among African experts on the diagnosis and treatment of poly-JIA using the Delphi technique. The first scientific committee identified a total of 15 key clinical questions according to the PICO (Patient/Population, Intervention, Comparison, Outcome) approach. A systematic review of the evidence-based literature was conducted for this work. The core steering group identified researchers and clinicians with expertise in pediatric rheumatology. A Delphi process was used to reach consensus.

Results: An online questionnaire was sent to the expert panel that participated in the survey (100% response rate). A total of 15 recommendation points were identified, divided into two parts: five recommendations for diagnosis and ten recommendations for management. The percentage of those who agreed with the recommendations (fourth and fifth place) ranged from 80 to 100%. All 15 clinical recommendation statements that the scientific committee had identified had been agreed upon in wording (i.e., 75% of respondents agreed or strongly agreed).

Conclusions: We successfully developed guidelines for children with polyarticular JIA, taking into consideration the African specific nature of limited resources and low income, also on the same time incorporating newly released data and using a treat to target approach.

Keywords: Africa; Guidelines; JIA; PAFLAR; Pediatric; Polyarticular JIA.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing of interests: The authors declare no competing interests.

Figures

**Fig. 1**
Treatment algorithm for polyarticular JIA

See this image and copyright information in PMC

References

1. Consolaro A, Giancane G, Schiappapietra B, Davi S, Calandra S, Lanni S, Ravelli A. Clinical outcome measures in juvenile Idiopathic Arthritis. Pediatr Rheumatol. 2016;14:23. - PMC - PubMed
1. Rose E, Petty TRS, Manners P, et al. International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;2:390–2. - PubMed
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African guidelines for diagnosis and management of polyarticular juvenile idiopathic arthritis: PAFLAR initiative

Affiliations

African guidelines for diagnosis and management of polyarticular juvenile idiopathic arthritis: PAFLAR initiative

Authors

Affiliations

Abstract

Conflict of interest statement

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References

MeSH terms

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LinkOut - more resources

Full Text Sources

Medical