Treatment of Juvenile Enthesitis-Related Arthritis with Active Sacroiliitis

Clinical Scenario

This protocol addresses patients with juvenile enthesitis-related arthritis (ERA) who present with active sacroiliitis — defined by prior or current MRI findings consistent with sacroiliitis, together with clinical examination findings such as pain on direct palpation of the sacroiliac joints, and/or patient-reported symptoms of inflammatory back pain.

Why This Scenario Matters

The combination of imaging evidence and clinical or symptomatic sacroiliac involvement identifies a specific sub-population of ERA patients whose management differs from those with peripheral arthritis alone. Both objective imaging findings and patient-reported inflammatory back pain are incorporated into the case definition to ensure no active sacroiliitis is overlooked.

Treatment Approach — Partial Overview

For children and adolescents in this scenario, a conventional antirheumatic therapy is conditionally recommended in selected patients — specifically those for whom certain biologic options are not suitable or have not provided sufficient benefit.

The full eligibility criteria, sequencing, and complete regimen are available in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

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, using sulfasalazine for patients who have contraindications to TNFi or have failed more than one TNFi is conditionally recommended.

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