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Polyarticular JIA — RACP Paediatrics MCQ

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HardRheumatologyPolyarticular JIARACP Paediatrics

A 13-year-old with rheumatoid-factor-positive polyarticular JIA still has eight active joints after 16 weeks of adherent subcutaneous methotrexate at an adequate dose. There is no active uveitis or systemic-JIA phenotype. Which disease-modifying escalation is most appropriate under Australian specialist care?

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Correct answer: B — Add a TNF inhibitor to the current methotrexate regimen

Explanation lettering: D = shown as A · E = shown as C · C = shown as D · A = shown as E

B is correct. Persistent active polyarticular JIA despite an adequate methotrexate trial warrants paediatric-rheumatology escalation to a biologic, commonly a TNF inhibitor; Australian PBS criteria explicitly recognise inadequate response to adequately dosed methotrexate. C creates unacceptable long-term glucocorticoid toxicity and is not disease-control strategy. D is reserved for exceptional organ-threatening autoimmune disease, not routine polyarticular JIA. E is impractical and does not control systemic joint risk. A is less effective than biologic escalation for this high-burden methotrexate-refractory phenotype. Agent choice also considers uveitis, comorbidity, vaccination and infection screening.

Reference: Australian Rheumatology Association: Paediatric Living Guidelines: https://rheumatology.org.au/For-Healthcare-Professionals/Australian-Living-Guidelines/Paediatric-Living-Guidelines Australian Government: Highly Specialised Drugs Program—juvenile idiopathic arthritis: https://www.legislation.gov.au/F2025L01215/asmade/2025-09-30/text/original/epub/OEBPS/document_1/document_1.html