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JIA treatment — SCE Rheumatology MCQ

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ModeratePaediatric RheumatologyJIA treatmentSCE Rheumatology

A 12-year-old girl has polyarticular RF-negative JIA with persistent synovitis in wrists, MCPs and knees despite NSAIDs and joint injections. Baseline bloods are normal and infection screening is negative. She has no uveitis. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Start methotrexate

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

Start methotrexate is best because methotrexate is a standard csDMARD for active polyarticular JIA. A is less suitable because delaying DMARDs risks joint damage and disability; B is less suitable because antibiotics do not treat chronic JIA; D is less suitable because allopurinol treats gout; E is less suitable because long-term high-dose prednisolone alone causes unacceptable toxicity. Clinical pearl: JIA management uses adult-like DMARD principles but with paediatric monitoring and safeguarding.

Reference: BSR JIA guidance; BNFc