A child has quotidian fever, evanescent rash and inflammatory polyarthritis after infection, malignancy and monogenic mimics are excluded. Fever

Question

A child has quotidian fever, evanescent rash and inflammatory polyarthritis after infection, malignancy and monogenic mimics are excluded. Fever settles on anakinra, but disabling arthritis persists despite adequate exposure. Which cytokine-directed switch is most coherent?

Accepted Answer

Switch to IL-6 receptor inhibition with tocilizumab

Answer

Use rituximab because B-cell depletion is the preferred treatment for systemic JIA arthritis

Answer

Replace anakinra with abatacept before trying another Still-disease cytokine target

Answer

Stop cytokine inhibition and use glucocorticoid monotherapy for twelve months

Answer

Add a TNF inhibitor to anakinra and continue dual biologic treatment

Systemic JIA — SCE Rheumatology MCQ

A child has quotidian fever, evanescent rash and inflammatory polyarthritis after infection, malignancy and monogenic mimics are excluded. Fever settles on anakinra, but disabling arthritis persists despite adequate exposure. Which cytokine-directed switch is most coherent?