A child has newly diagnosed systemic juvenile idiopathic arthritis with quotidian fever, arthritis and systemic inflammation; infection, malignancy

Question

A child has newly diagnosed systemic juvenile idiopathic arthritis with quotidian fever, arthritis and systemic inflammation; infection, malignancy and macrophage-activation syndrome have been excluded. Which initial strategy best minimises prolonged glucocorticoid exposure?

Accepted Answer

Start an interleukin-1 or interleukin-6 inhibitor early in treatment

Answer

Start methotrexate first to control the systemic inflammatory phenotype

Answer

Start tumour-necrosis-factor inhibition before cytokine-directed treatment

Answer

Use prolonged oral glucocorticoid monotherapy before adding a biologic

Answer

Use NSAID monotherapy for six months before disease modification

Systemic JIA — SCE Rheumatology MCQ

A child has newly diagnosed systemic juvenile idiopathic arthritis with quotidian fever, arthritis and systemic inflammation; infection, malignancy and macrophage-activation syndrome have been excluded. Which initial strategy best minimises prolonged glucocorticoid exposure?