This protocol addresses children under 16 with juvenile idiopathic arthritis (JIA) who present with active sacroiliitis — confirmed by both magnetic resonance imaging findings and clinical examination consistent with sacroiliitis or inflammatory back pain — and who have no contraindication to tumor necrosis factor inhibitor therapy.
For children in this population, a specific anti-inflammatory pharmacological approach is strongly recommended as the first-line treatment over no treatment. The complete regimen — including agent selection, sequencing, and monitoring — is available in the full structured protocol.
This group includes patients with active sacroiliitis who will most likely be classified within the ILAR categories of enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis, but may include patients in any of the ILAR JIA categories.
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, treatment with an NSAID is strongly recommended over no treatment with an NSAID.
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