Therapeutic options in psoriatic juvenile idiopathic arthritis

Drug	Dose
Intraarticular glucocorticoids
Triamcinolone hexacetonide	0.5 to 1 mg/kg intraarticular, up to 40 mg depending on size of joint. Most effective glucocorticoid for joint injections; not for soft tissue injections.
Methylprednisolone acetate	1 mg/kg intraarticular or soft tissue (including dactylitis), up to 80 mg depending upon size of joint or lesion
Nonsteroidal antiinflammatory drugs (NSAIDs)
Naproxen	5 to 10 mg/kg/dose orally twice daily (maximum 1000 mg/day)
Ibuprofen	10 mg/kg/dose orally 3 to 4 times daily (maximum 2.4 g/day)
Celecoxib	Body weight dosing: 10 to 25 kg – 50 mg orally twice daily >25 kg – 100 mg orally twice daily Adult – 200 mg orally once to twice daily
Disease-modifying antirheumatic drugs
Methotrexate*	10 to 15 mg/m² per week or 0.5 to 1 mg/kg/week (maximum 25 mg per week) administered orally* or subcutaneously with folic acid 1 mg daily or leucovorin calcium
Sulfasalazine	15 to 30 mg/kg/dose orally twice daily (maximum 3 g/day)
Leflunomide	Body weight dosing: <20 kg – 10 mg orally every other day 20 to 40 kg – 10 mg orally daily >40 kg – 20 mg orally daily
Third-line agents in uveitis
Mycophenolate mofetil^¶	12 to 18 mg/kg or 600 mg/m² orally twice per day (maximum 3 g/day)^¶
Cyclosporine (microemulsion)	1.5 to 2.5 mg/kg orally twice per day
Azathioprine	1 to 2 mg/kg orally once per day or in 2 equal divided doses
Tumor necrosis factor (TNF) inhibitors
Adalimumab	Body weight dosing: 15 to 30 kg – 20 mg subcutaneously every 2 weeks ≥30 kg – 40 mg subcutaneously every 2 weeks (may escalate to weekly for partial response)
Etanercept	0.8 mg/kg (maximum 50 mg) subcutaneously weekly
Infliximab	5 to 10 mg/kg intravenously every 4 to 8 weeks (after loading doses)
Golimumab	Intravenous: Children ≥2 years – 80 mg/m² weeks 0 and 4, then every 8 weeks (maximum dose 240 mg) Adults – 2 mg/kg weeks 0 and 4, then every 8 weeks (no defined maximum dose) Subcutaneous (no pediatric indication) – 50 mg monthly
Certolizumab (no pediatric indication)	200 mg subcutaneously every 2 weeks (after loading doses)
Phosphodiesterase 4 (PDE4) inhibitor
Apremilast (no pediatric indication)	30 mg twice daily (begin 10 mg daily and increase over 6 days to achieve target dose)
IL-17 inhibitor (patients ≥2 years)
Secukinumab	Subcutaneous injection weeks 0, 1, 2, 3, 4, then every 4 weeks Body weight dosing: ≥15 kg through ≤50 kg – 75 mg/dose ≥50 kg – 150 mg/dose
IL-12/23 inhibitor (patients ≥6 years)
Ustekinumab	Subcutaneous injection weeks 0 and 4, then every 12 weeks Body weight dosing: <60 kg – 0.75 mg/kg/dose 60 to 100 kg – 45 mg/dose >100 kg – 90 mg/dose
CTLA4-Ig (T cell costimulatory blocker)
Abatacept	10 mg/kg (maximum 1000 mg) intravenously every 4 weeks

NOTE: Treatment should be performed by clinicians who are experienced in the use, monitoring, adjustment, and drug interactions of these agents because of the potential toxicity of these drugs/combinations and the unpredictability of the disease.

* Divided oral dosing or subcutaneous administration is suggested for methotrexate doses >10 mg/m² since oral absorption decreases with higher doses.

¶ Mycophenolate mofetil dosing shown is for immediate release oral preparation. Dose adjustment is required for conversion to the delayed-release oral preparation.

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Therapeutic options in psoriatic juvenile idiopathic arthritis