This protocol addresses polyarticular juvenile idiopathic arthritis in patients under 16 who have active sacroiliitis confirmed by MRI and clinical findings, and who have a contraindication to tumor necrosis factor inhibitor therapy.
Current evidence strongly supports NSAID treatment as part of the management approach for active sacroiliitis in this population. The full structured regimen — including sequencing and all relevant considerations — is available in the complete protocol.
DOI: 10.1002/acr.23870
In children and adolescents with active sacroiliitis, treatment with an NSAID is strongly recommended over no treatment with an NSAID.
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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