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Oligoarticular juvenile idiopathic arthritis — SCE Rheumatology MCQ

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HardPaediatric rheumatologyOligoarticular juvenile idiopathic arthritisSCE Rheumatology

A child with polyarticular JIA has active synovitis in eight joints despite NSAIDs and two joint injections. Which systemic disease-modifying treatment is usually introduced first?

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Correct answer: A — Weekly methotrexate with folate and laboratory monitoring

Persistent polyarticular JIA needs systemic disease modification to prevent joint damage and growth disturbance. Weekly methotrexate is the usual first csDMARD, supported by folate, family education and risk-adapted blood monitoring.

Reference: 2025 BSR guideline for prescription and monitoring of conventional synthetic DMARDs (Published November 2025): https://academic.oup.com/rheumatology/article/65/2/keaf522/8322743; NICE TA373: biologic treatments for juvenile idiopathic arthritis (Published December 2015): https://www.nice.org.uk/guidance/ta373/chapter/1-Recommendations