Version July 2025
bDMARD: biologic disease-modifying antirheumatic drug; csDMARD: conventional synthetic disease-modifying antirheumatic drug; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; IA: intra-articular; JIA: juvenile idiopathic arthritis; NSAID: nonsteroidal antiinflammatory drug; TMJ: temporomandibular joint; TNF: tumor necrosis factor.
* Erosions may be more difficult to detect on radiographs in children than in adults.
¶ Short-term NSAID monotherapy may be used as an alternative approach if the diagnostic evaluation is not complete, arthritis has been present for less than 6 weeks, and/or the caregiver is very hesitant about intervention. If joint swelling persists, we treat with IA glucocorticoids and/or other DMARDs.
Δ We stop the csDMARD if it has not provided any benefit or has caused significant adverse effects; otherwise, we generally add a bDMARD to existing therapy. The choice of bDMARD depends upon provider and family preferences and disease complications (eg, uveitis). For more information, refer to UpToDate content on oligoarticular JIA.