Summary : This flowchart presents a treatment algorithm for temporomandibular joint (TMJ) arthritis in patients with juvenile idiopathic arthritis (JIA), outlining conditional and strong recommendations for medication choices based on response or intolerance. flowchart: # Nodes : • Start (ellipse): "JIA with active TMJ arthritis" • Treatment options (rectangles, light green): "Trial of scheduled NSAIDs", "Intra-articular glucocorticoids (no preferred agent)" • Decision point (diamond): "Incomplete response or intolerance?" • Treatment options (rectangles, light green): "Biologic DMARD (no preferred agent)" • Treatment option (rectangle, dark green): "Non-biologic DMARD MTX over LEF" • Decision point (diamond): "Incomplete response or intolerance?" • Treatment option (rectangle, light green): "Add or switch biologic DMARD (no preferred agent)" • Treatment option (rectangle, light green): "Continue treatment and monitor" # Connectors : • Downward arrows from "JIA with active TMJ arthritis" to both "Trial of scheduled NSAIDs" and "Intra-articular glucocorticoids (no preferred agent)" (parallel options). • Both treatment options lead to the decision point "Incomplete response or intolerance?" • "No" branch from decision point leads to "Continue treatment and monitor". • "Yes" branch leads to two parallel options: "Biologic DMARD (no preferred agent)" and "Non-biologic DMARD MTX over LEF". • Both DMARD options lead to a second decision point: "Incomplete response or intolerance?" • "No" branch from second decision point leads to "Continue treatment and monitor". • "Yes" branch leads to "Add or switch biologic DMARD (no preferred agent)". # Layout : • Top-down flow, starting with disease presentation, followed by initial treatment options, then branching based on response. • Parallel options for initial and secondary treatments. • Decision diamonds split into "Yes" and "No" branches. • Strong recommendations (dark green) and conditional recommendations (light green) are visually distinguished. • Legend at top left explains shapes and colour codes. # Analysis : • The algorithm prioritises NSAIDs and intra-articular glucocorticoids as initial treatments, with escalation to DMARDs if response is incomplete or intolerance occurs. • Methotrexate (MTX) is preferred over leflunomide (LEF) for non-biologic DMARDs. • Biologic DMARDs are recommended if non-biologic DMARDs are insufficient, with further switching if needed. • Monitoring is advised for patients who respond adequately at any stage. • The flowchart visually separates strong recommendations (non-biologic DMARD, MTX over LEF) from conditional ones, guiding clinicians through a stepwise escalation based on patient response.

Summary : This flowchart presents a treatment algorithm for oligoarthritis in patients with untreated juvenile idiopathic arthritis (JIA), outlining stepwise therapeutic options and decision points based on response or intolerance, with additional considerations for risk factors and disease activity assessment. flowchart: # Nodes : • Start (ellipse): "Untreated JIA with oligoarthritis" • Treatment options (rectangles): – "Intra-articular glucocorticoids Triamcinolone hexacetonide" (dark green, strong recommendation) – "Trial of scheduled NSAIDs" (light green, conditional recommendation) • Decision point (diamond): "Incomplete response or intolerance?" • Treatment options (rectangles): – "Non-biologic DMARD MTX over LEF, SSZ, or HCQ" (dark green, strong recommendation) – "Continue treatment (for NSAIDs) and observation" (light green, conditional recommendation) • Decision point (diamond): "Incomplete response or intolerance?" • Treatment options (rectangles): – "Biologic DMARD (no preferred agent)" (dark green, strong recommendation) – "Continue treatment and monitor" (light green, conditional recommendation) • Additional considerations (rectangles): – "Risk factors: involvement of ankle, wrist, hip and/or TMJ; presence of erosive disease; delay in diagnosis; elevated inflammatory markers; symmetric disease" – "Use validated disease activity measures to facilitate treat-to-target" • Legend (rectangle): Explains shapes and colour codes for presentation, decision points, assessed disease status, and recommendation strength. # Connectors : • Downward arrows from "Untreated JIA with oligoarthritis" to both "Intra-articular glucocorticoids Triamcinolone hexacetonide" and "Trial of scheduled NSAIDs" (parallel, "and/or"). • Both treatment options converge to the first decision diamond: "Incomplete response or intolerance?" • "Yes" branch leads to "Non-biologic DMARD MTX over LEF, SSZ, or HCQ"; "No" branch leads to "Continue treatment (for NSAIDs) and observation". • From "Non-biologic DMARD MTX over LEF, SSZ, or HCQ", arrow to second decision diamond: "Incomplete response or intolerance?" • "Yes" branch leads to "Biologic DMARD (no preferred agent)"; "No" branch leads to "Continue treatment and monitor". • Additional considerations and legend are placed to the right, not directly connected to the main flow. # Layout : • Vertical flow from top (presentation) to bottom (advanced treatment options). • Parallel initial treatment options, merging at first decision point. • Two sequential decision diamonds, each splitting into two branches. • Additional considerations and legend are in side boxes, visually separated from the main algorithm. # Analysis : • The algorithm is structured to escalate therapy based on incomplete response or intolerance, starting with intra-articular glucocorticoids and/or NSAIDs, then progressing to non-biologic DMARDs, and finally to biologic DMARDs if needed. • Strong recommendations (dark green) are given for intra-articular glucocorticoids, non-biologic DMARDs (MTX preferred), and biologic DMARDs, while NSAIDs and continued monitoring are conditional (light green). • Risk factors and validated disease activity measures are highlighted as important considerations for tailoring treatment and monitoring. • The flowchart provides a clear, stepwise approach to managing oligoarthritis in JIA, emphasizing treat-to-target strategies and escalation based on patient response.

This composite educational figure illustrates the anti-inflammatory and joint-protective effects of various drug treatments (Actarit and Ketoprofen formulations) in a rat model of Rheumatoid Arthritis (RA). Section (a) features H&E-stained histological sections of knee joints, clinical photographs of hind paw edema, and radiographic (X-ray) images of the tarsometatarsal joints across seven groups (Control, Model, AT, AAT, KAT, OAK, AKAT). Red arrows on the X-rays highlight areas of bone erosion and joint space narrowing, most prominent in the Model group and least in the AKAT group. (b) and (c) are bar graphs showing serum concentrations of pro-inflammatory cytokines TNF-α and IL-6, illustrating therapeutic downregulation. (d) presents footprint analysis with labeled stride length and width, while (e) and (f) provide the corresponding statistical gait analysis, showing functional motor recovery. (g) depicts skin barrier function through melanin and trans-epidermal water loss (TEWL) measurements. This figure demonstrates the synergistic efficacy of combined DMARD and NSAID topical treatment in suppressing synovial proliferation and cartilage destruction.