Treatment of Polyarticular JIA with Active Enthesitis When TNF Inhibitors Are Contraindicated

This protocol addresses patients under 16 years with juvenile idiopathic arthritis who have active enthesitis — tenderness and/or swelling at tendon-to-bone insertion sites that requires medical treatment — and a contraindication to TNF inhibitors. This combination defines a distinct therapeutic challenge requiring a tailored first-line approach.

Affected patients are most likely from the enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis categories, though any JIA subtype may be represented. Active enthesitis here means tenderness and/or swelling at the entheses that the treating provider has determined requires medical treatment.

When TNF inhibitors are not an option, oral disease-modifying therapy is among the approaches considered for this population. Physical therapy is also an important component for patients who have or are at risk for functional limitations. The complete protocol — including specific agents, sequencing, and supporting therapies — is available via the link below.