Oligoarticular JIA: What to Do When Scheduled NSAIDs and Intraarticular Glucocorticoids Have Not Achieved Inactive Disease
In active oligoarticular juvenile idiopathic arthritis, first-line management centres on scheduled NSAIDs and intraarticular glucocorticoid injections. When these measures do not achieve the clinical target of inactive disease, a structured next-line approach is indicated.
Prior therapy — inadequate response
A trial of scheduled NSAIDs and/or intraarticular glucocorticoid injection — with triamcinolone hexacetonide (preferred) or triamcinolone acetonide — was pursued with the goal of achieving inactive disease. Failure to reach that target is the trigger for escalation.
Next-line approach
This protocol introduces conventional synthetic disease-modifying therapy, with Methotrexate as the preferred first agent, aimed at achieving inactive disease. The complete agent selection, preferred routes, and sequencing are detailed in the full protocol.
References
DOI: 10.1002/art.42037
- Conventional synthetic DMARDs are strongly recommended if there is an inadequate response to scheduled NSAIDs and/or IAGCs for active oligoarthritis.
- Methotrexate is conditionally recommended as a preferred agent over leflunomide, sulfasalazine, or hydroxychloroquine (in that order).
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