PANLAR 2025 Recommendations for Polyarticular Juvenile Idiopathic Arthritis in Latin America — Practical, Evidence-Based Guidance for Resource-Variable Settings

Introduction and Context

Polyarticular juvenile idiopathic arthritis (poly-JIA) — arthritis affecting five or more joints in children — is one of the more aggressive paediatric inflammatory arthritides. In 2025 the Pan‑American League of Associations for Rheumatology (PANLAR) published a focused guideline in Lancet Child & Adolescent Health specifically addressing pharmacological treatment of non-systemic poly-JIA across Latin America (Gutiérrez‑Suárez et al., Lancet Child Adolesc Health 2025). The guideline was created by a region-wide panel of paediatric rheumatologists and methodologists using GRADE methodology and rigorous systematic review of the evidence.

Why this guideline now? Three forces prompted PANLAR to develop region-specific recommendations:
– Clinical gaps and inequities: children in Latin America often face delayed diagnosis, limited access to paediatric rheumatologists, and restricted availability of costly biologic therapies, producing higher disease activity and worse outcomes compared with high-income countries (Consolaro et al., Lancet Child Adolesc Health 2019).
– New evidence and therapeutics: recent randomized trials and registry data clarify optimal methotrexate dosing and routes, support early combination therapy with biologics, and expand the evidence base for JAK inhibitors and other biologics in refractory disease (Ruperto et al., Lancet 2021; Ramanan et al., Lancet 2023).
– Need for pragmatic, resource-aware guidance: WHO’s Model List of Essential Medicines for Children now includes several DMARDs and biologics, but availability remains uneven; PANLAR aimed to combine best evidence with realistic alternatives for constrained health systems.