Treatment of Juvenile Idiopathic Arthritis:Therapeutic Approaches for Non‐Systemic Polyarthritis, Sacroiliitis, and Enthesitis

Publication Date: April 25, 2019

Last Updated: December 15, 2022

Treatment

Table 3. General medication recommendations for children and adolescents with JIA and polyarthritis

Each recommendation is preceded by the phrase: “In children and adolescents with JIA and active polyarthritis…”

NSAIDs

NSAIDs are conditionally recommended as adjunct therapy. (, Very Low )

607

DMARDs

Using methotrexate is conditionally recommended over leflunomide or sulfasalazine.

leflunomide (, Moderate )

607

sulfasalazine (, Very Low )

607

Using subcutaneous methotrexate is conditionally recommended over oral methotrexate. (, Very Low )

607

Glucocorticoids

Intra-articular glucocorticoids are conditionally recommended as adjunct therapy. (, Very Low )

607

Triamcinolone hexacetonide is strongly recommended over triamcinolone acetonide for intra-articular glucocorticoid injections. (, Moderate )

607

Bridging therapy with a limited course of oral glucocorticoid (<3 months) during initiation or escalation of therapy in patients with high or moderate disease activity is conditionally recommended.^a

Bridging therapy may be of most utility in the setting of limited mobility and/or significant symptoms.

(, Very Low )

^a A bridging course of oral glucocorticoids was defined as a short course (<3 months) of oral glucocorticoids intended to control disease activity quickly during the initiation or escalation of therapy. An adequate trial of methotrexate was considered to be 3 months. If no or minimal response is observed after 6–8 weeks, it was agreed that changing or adding therapy may be appropriate.

607

Conditionally recommend against bridging therapy with a limited course of oral glucocorticoid (<3 months) in patients with low disease activity. (, Very Low )

607

Strongly recommend against adding chronic low-dose glucocorticoid, irrespective of risk factors or disease activity. (, Very Low )

607

Biologic DMARDs

In children and adolescents with JIA and polyarthritis, initiating treatment with a biologic combination therapy with a DMARD is conditionally recommended over biologic monotherapy.

etanercept, golimumab (, Very Low )

607

abatacept, or tocilizumab (, Low )

607

adalimumab (, Moderate )

607

Combination therapy with a DMARD is strongly recommended for infliximab. (, Low )

607

Physical therapy and occupational therapy

In children and adolescents with JIA and polyarthritis who have or are at risk of functional limitations, using physical therapy and/or occupational therapy is conditionally recommended.

physical therapy (, Low )

607

occupational therapy (, Very Low )

607

Overview

Title

Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non‐Systemic Polyarthritis, Sacroiliitis, and Enthesitis