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Polyarticular juvenile idiopathic arthritis — SCE Rheumatology MCQ

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HardPaediatric rheumatologyPolyarticular juvenile idiopathic arthritisSCE Rheumatology

A 12-year-old with polyarticular JIA has persistent active synovitis despite methotrexate. Screening before biologic therapy shows negative TB IGRA, negative hepatitis B surface antigen and normal varicella immunity. What is the most appropriate next management?

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Correct answer: A — Escalate to biologic therapy through paediatric rheumatology pathway

Persistent active polyarticular JIA despite methotrexate warrants specialist escalation, commonly to biologic therapy after safety screening. Waiting for erosions risks permanent damage and growth effects. Long-term steroids are not an acceptable sole disease-control strategy.

Reference: NICE technology appraisals for JIA biologics; BSR rheumatology curriculum