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. 2023 Sep 12;11:1218312. doi: 10.3389/fped.2023.1218312

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© 2023 Foley, McKenna, Gallagher, McLellan, Alkhdher, Lacassagne, Moraitis, Papadopoulou, Pilkington, Al Obaidi, Eleftheriou and Brogan.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Recommended treatment algorithm for sJIA. max, maximum; IV, intravenous; SC, subcutaneous; MTX, methotrexate; anti-TNF, anti-tumour necrosis factor. Methotrexate (MTX; oral or subcutaneous) may be used at any stage in sJIA particularly if there is evidence of polyarticular arthritis. *Glucocorticoids are usually administered with anakinra for newly presenting patients; however, anakinra may be considered as monotherapy for select patients under close monitoring and expert review (48). **Alternative biologics to consider: anti-TNF, abatacept, or other. Reports of small molecules JAKi have also suggested efficacy and safety (51), but ongoing clinical trials of this treatment for sJIA have not yet completed; therefore, JAKi cannot be recommended with a high level of evidence.