This protocol addresses children and adolescents with juvenile idiopathic arthritis (JIA) who present with active enthesitis — entheseal tenderness and/or swelling at tendon-to-bone insertion sites that the treating provider has determined requires medical treatment.
Active enthesitis in JIA encompasses patients from multiple ILAR categories — most commonly enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis — whose entheseal inflammation is clinically significant enough to warrant pharmacological management.
A TNF-targeting biologic is the preferred pharmacologic approach; alternative systemic therapies and physical therapy also apply for specific patient profiles. The complete treatment pathway — including selection, sequencing, and adjunctive measures — is in the full protocol.
DOI: 10.1002/acr.23870
This group is intended to include patients with enthesitis (inflammation at tendon-to-bone insertion sites) who will also most likely be from the ILAR categories of enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis but may include patients from any of the ILAR JIA categories.
For the purposes of this guideline, active enthesitis is tenderness and/or swelling of the entheses determined to require medical treatment per the treating provider.
In children and adolescents with JIA and active enthesitis despite treatment with NSAIDs, using a TNFi is conditionally recommended over methotrexate or sulfasalazine.
While TNFi is preferred, the Voting Panel discussed that a trial of methotrexate or sulfasalazine may be warranted for patients with contraindications to TNFi, patients with mild enthesitis, and patients with concomitant active peripheral polyarthritis.
In children and adolescents with JIA and enthesitis who have or are at risk for functional limitations, using PT is conditionally recommended.
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