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Systemic juvenile idiopathic arthritis — SCE Rheumatology MCQ

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HardPaediatric rheumatologySystemic juvenile idiopathic arthritisSCE Rheumatology

An adult with Still disease has persistent destructive polyarthritis despite an adequate anakinra trial; systemic features are controlled, infection has been excluded and glucocorticoid reduction remains impossible. Which biologic switch is most coherent?

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Reveal the answer and explanation

Correct answer: D — Switch to tocilizumab and continue a structured glucocorticoid taper

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

E is correct. Tocilizumab targets IL-6, a principal Still-disease pathway, and is a rational alternative after inadequate IL-1 control, particularly with persistent polyarthritis. A combines biologics without a routine evidence or safety basis. B and C choose less-supported mechanisms before the other principal cytokine target. D abandons the steroid-sparing treatment goal.

Reference: EULAR/PReS recommendations for diagnosis and management of Still disease: https://pmc.ncbi.nlm.nih.gov/articles/PMC11672000/