This protocol addresses children under 16 years of age with juvenile idiopathic arthritis who have active enthesitis — tenderness and/or swelling of the entheses requiring medical treatment — and no contraindication to tumor necrosis factor inhibitor therapy.
Active enthesitis in JIA encompasses inflammation at tendon-to-bone insertion sites and may arise across ILAR categories, including enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis, though patients from any JIA category may be affected. Active enthesitis is defined as tenderness and/or swelling of the entheses determined to require medical treatment per the treating provider.
In this setting, management centres on a targeted biologic approach involving tumor necrosis factor inhibition. A short bridging course of oral anti-inflammatory therapy may be considered during treatment initiation, and physical therapy is part of the plan for patients with or at risk of functional limitations. The complete regimen — including agent selection, sequencing, and all supporting criteria — is available in the full protocol.
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 despite treatment with NSAIDs, using a TNFi is conditionally recommended over methotrexate or sulfasalazine.
In children and adolescents with JIA and chronic active enthesitis 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 JIA and enthesitis who have or are at risk for functional limitations, using PT is conditionally recommended.
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