This protocol addresses patients under 16 years of age who have juvenile idiopathic arthritis with active sacroiliitis — established by magnetic resonance imaging findings consistent with sacroiliitis together with clinical examination findings or patient-reported inflammatory back pain — and in whom tumor necrosis factor inhibitors are contraindicated.
Active sacroiliitis in juvenile idiopathic arthritis may arise across multiple ILAR JIA categories, including enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. Patients meet the active sacroiliitis criterion when prior or current MRI findings are consistent with sacroiliitis alongside clinical examination findings — such as pain on direct palpation of the sacroiliac joints — and/or patient-reported inflammatory back pain.
When TNF inhibitors are contraindicated, a conditionally recommended oral agent forms the foundation of the evidence-based approach for this age group — additional adjunct and supportive options may also be considered. The complete structured regimen is available in the full 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.
Using sulfasalazine for patients who have contraindications to TNFi or have failed more than one TNFi is conditionally recommended.
View source ↗