This protocol applies to children and adolescents with juvenile enthesitis-related arthritis who present with active sacroiliitis — defined by prior or current MRI findings consistent with sacroiliitis together with clinical examination findings and/or patient-reported symptoms of inflammatory back pain.
Active sacroiliitis is established when MRI findings consistent with sacroiliitis are present alongside clinical evidence — such as pain on direct palpation of the sacroiliac joints — and/or patient-reported symptoms of inflammatory back pain. This combination defines the specific population for whom this structured regimen is indicated.
When NSAID therapy alone fails to control active sacroiliitis, the protocol addresses escalation to a TNF inhibitor added to existing NSAID treatment. The full regimen — including adjunct interventions and supportive measures — is detailed in the complete protocol.
DOI: 10.1002/acr.23870
For the purposes of this guideline, patients were considered to have active sacroiliitis if they had prior or current magnetic resonance imaging findings consistent with sacroiliitis along with clinical examination findings consistent with sacroiliitis (e.g., pain with direct palpation of the sacroiliac joints) and/or patient-reported symptoms of inflammatory back pain.
In children and adolescents with active sacroiliitis despite NSAIDs, adding a TNFi is strongly recommended over continued NSAID monotherapy.
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