Polyarticular JIA with 5 or More Joints: What to Do When Prior Biologic Therapy Has Not Achieved Low Disease Activity

This protocol applies to children under 16 years with juvenile idiopathic arthritis (JIA) — non-systemic polyarthritis involving five or more joints ever affected — where systemic arthritis and sacroiliitis are absent, and where the previous biologic therapy has not reached the disease activity target.

Clinical scenario

Juvenile idiopathic arthritis (JIA) defines a heterogeneous collection of inflammatory arthritides of unknown etiology with onset prior to age 16 years and a minimum duration of 6 weeks. This subgroup covers children with polyarthritis (five or more joints ever involved) from different JIA categories, excluding those with systemic arthritis or sacroiliitis.

Previous therapy that did not achieve the target

The preceding treatment step involved switching to a non-TNFi biologic — tocilizumab or abatacept — or, in selected patients with secondary failure of a first TNFi, a second TNFi (such as etanercept, adalimumab, golimumab, or infliximab). If that approach did not achieve low disease activity (cJADAS-10 ≤2.5), this protocol defines the next therapeutic step.

Treatment approach (overview only)

The recommended approach at this stage involves selection from a specific set of biologic agents, with the choice guided by which biologics the patient has previously received. See the full protocol for the complete algorithm and conditionally recommended options.

Treatment goal

The target for this protocol is low disease activity (cJADAS-10 ≤2.5).

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1002/acr.23870

This group includes children with JIA and polyarthritis (≥5 joints ever involved) and may include children from different ILAR JIA categories but excludes children with systemic arthritis or sacroiliitis.
The term juvenile idiopathic arthritis (JIA) defines a heterogeneous collection of inflammatory arthritides of unknown etiology with onset prior to age 16 years and a minimum duration of 6 weeks, following the exclusion of other known causes of synovitis.
In patients with JIA and polyarthritis and moderate or high disease activity despite a second biologic, using a TNFi, abatacept, or tocilizumab (depending upon prior biologics received) is conditionally recommended over rituximab.
Good disease control, with therapeutic escalation to achieve low disease activity, was recommended.

View source ↗