Treatment recommendations for patients with a history of arthritis of 5 or more joints. These recommendations are intended for patients with juvenile idiopathic arthritis who have developed active arthritis in 5 or more joints in total throughout the history of their disease and are based upon duration of current therapy, disease activity, and features of poor prognosis. If criteria for escalation of therapy are not met, then continue current therapy along with adjunct nonsteroidal antiinflammatory drugs (NSAIDs) or glucocorticoid joint injections, as needed. Recommendations for reduction of therapy are not addressed. See Table 2 for definitions of disease activity and features of poor prognosis. * = leflunomide may be an appropriate treatment alternative (see text for details); MTX = methotrexate; TNFα = tumor necrosis factor α.

Treatment recommendations for patients with systemic arthritis and active arthritis (and without active systemic features). These recommendations are intended for patients with juvenile idiopathic arthritis who have systemic arthritis with active arthritis and without active systemic features. Recommendations are based upon duration of current therapy, disease activity, and features of poor prognosis. If criteria for escalation of therapy are not met, then continue current therapy along with adjunct nonsteroidal antiinflammatory drugs (NSAIDs), as needed. Recommendations for reduction of therapy are not addressed. See Table 5 for definitions of disease activity and features of poor prognosis. MTX = methotrexate; TFNα = tumor necrosis factor α; * = initiation of anakinra for the treatment of arthritis may be less appropriate later in the disease course compared to nearer the onset of disease; † = switching from anakinra to a TNFα inhibitor may be appropriate for some patients with moderate or high disease activity, irrespective of features of poor prognosis, but there is a possible risk of unmasking latent systemic features when discontinuing anakinra.

Treatment recommendations for patients with a history of arthritis of 4 or fewer joints. These recommendations are intended for patients with juvenile idiopathic arthritis (JIA) who have only developed active arthritis in 4 or fewer joints in total throughout the history of their disease course and are based upon duration of current therapy, disease activity, and features of poor prognosis. If criteria for escalation of therapy are not met, then continue current therapy along with adjunct nonsteroidal antiinflammatory drugs (NSAIDs) or glucocorticoid joint injections, as needed. Recommendations for reduction of therapy are not addressed. See Table 1 for definitions of disease activity and features of poor prognosis. * = sulfasalazine may be an appropriate treatment for patients with the enthesitis-related arthritis category of JIA (see text for details); MTX = methotrexate; TNFα = tumor necrosis factor α.

Treatment recommendations for patients with systemic arthritis and active systemic features (and without active arthritis). These recommendations are intended for patients with juvenile idiopathic arthritis who have systemic arthritis with active systemic features and without active arthritis. Recommendations are based upon duration of current therapy, disease activity, and features of poor prognosis. If criteria for escalation of therapy are not met, then continue current therapy along with adjunct nonsteroidal antiinflammatory drugs (NSAIDs), as needed. Recommendations for reduction of therapy are not addressed. See Table 4 for definitions of disease activity and features of poor prognosis. MD Global = physician global assessment of overall disease activity (range 0---10).