Treatment of Polyarticular Juvenile Idiopathic Arthritis with Active Sacroiliitis in Children Under 16
Clinical Scenario
This protocol addresses patients under 16 years of age with juvenile idiopathic arthritis who have active sacroiliitis confirmed by magnetic resonance imaging findings consistent with sacroiliitis together with clinical examination findings consistent with sacroiliitis or patient-reported inflammatory back pain, and who have no contraindication to a tumor necrosis factor inhibitor.
Juvenile idiopathic arthritis
Active sacroiliitis
MRI-confirmed
Age < 16 years
No TNFi contraindication
About This Presentation
Patients in this group are most often classified within ILAR categories such as enthesitis-related arthritis, psoriatic arthritis, or undifferentiated arthritis, though any ILAR JIA category may be represented. Active sacroiliitis is identified by the co-occurrence of imaging evidence and clinical signs — including pain with direct palpation of the sacroiliac joints — and/or inflammatory back pain reported by the patient.
Treatment Approach — Partial Overview
For children and adolescents with active sacroiliitis in this setting, the evidence-based approach centres on the addition of a tumor necrosis factor inhibitor (TNFi), alongside adjunct options during therapy initiation and measures to address functional limitations. The complete structured regimen — specific agents, adjunct therapy sequencing, and physical therapy guidance — is available in the full protocol.
References
DOI: 10.1002/acr.23870
- 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 despite NSAIDs, adding a TNFi is strongly recommended over continued NSAID monotherapy.
- In children and adolescents with active sacroiliitis despite treatment with NSAIDs, bridging therapy with a limited course of oral glucocorticoids (<3 months) during initiation or escalation of therapy is conditionally recommended.
- In children and adolescents with active sacroiliitis despite treatment with NSAIDs, intraarticular glucocorticoid injection of the sacroiliac joints as adjunct therapy is conditionally recommended.
- In children and adolescents with sacroiliitis who have or are at risk for functional limitations, using PT is conditionally recommended.
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