Treatment of Polyarticular JIA with Active Enthesitis in Children Under 16

This protocol applies to children and adolescents under 16 years of age with juvenile idiopathic arthritis who present with active enthesitis — tenderness and/or swelling of the entheses determined to require medical treatment — and who have no contraindication to tumor necrosis factor inhibitor therapy.

Clinical Scenario

Juvenile idiopathic arthritis (JIA)
Active enthesitis: tenderness and/or swelling at entheses requiring medical treatment
No contraindication to tumor necrosis factor inhibitor
Age under 16 years

This population commonly includes patients from the ILAR categories of enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis, though patients from any JIA category may be included.

Treatment Approach (partial)

For this population, the protocol begins with a specific class of anti-inflammatory agents as the primary recommended initial intervention.

Full regimen, sequencing, and clinical decision points are available in the complete protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1002/acr.23870

This group is intended to include patients with enthesitis (inflammation at tendon-to-bone insertion sites) who will also most likely be from the ILAR categories of enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis but may include patients from any of the ILAR JIA categories.

For the purposes of this guideline, active enthesitis is tenderness and/or swelling of the entheses determined to require medical treatment per the treating provider.

In children and adolescents with JIA and active enthesitis, NSAID treatment is strongly recommended over no treatment with an NSAID.

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