Polyarticular JIA with Active Sacroiliitis: Treatment in Patients Under 16
This protocol addresses children under 16 years with juvenile idiopathic arthritis presenting with active sacroiliitis — confirmed by magnetic resonance imaging findings and consistent clinical examination or inflammatory back pain — who have no contraindication to tumor necrosis factor inhibitor therapy.
Clinical Scenario
- Juvenile idiopathic arthritis, active
- MRI findings consistent with sacroiliitis
- Clinical examination findings consistent with sacroiliitis, or inflammatory back pain
- No contraindication to tumor necrosis factor inhibitor
- Age under 16 years
Treatment Approach
The protocol for this scenario incorporates Sulfasalazine as part of the pharmacological approach. The complete regimen, sequencing, and full clinical decision pathway are available in the structured protocol.
Full regimen details, decision algorithm, and supporting evidence accessible via the link below.
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.
- Using sulfasalazine for patients who have contraindications to TNFi or have failed more than one TNFi is conditionally recommended.
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