Table 5.

Recommendations for the initial and subsequent treatment of children and adolescents with JIA and sacroiliitis^*

Recommendation	Level of evidence
Initial treatment
In children and adolescents with active sacroiliitis, treatment with an NSAID is strongly recommended over no treatment with an NSAID (PICO C.1).	Very low
In children and adolescents with active sacroiliitis despite treatment with NSAIDs:
• Adding TNFi is strongly recommended over continued NSAID monotherapy (PICO C.2).	Low
• Using sulfasalazine for patients who have contraindications to or have failed a TNFi is conditionally recommended (PICO C.3).	Low
• Strongly recommend against using methotrexate monotherapy (PICO C.4).	Very low
Glucocorticoids
In children and adolescents with active sacroiliitis despite treatment with NSAIDs:
• Bridging therapy with a limited course of oral	Very low
• glucocorticoid (<3 months) during initiation or escalation of therapy is conditionally recommended (PICO C.5).†
Bridging therapy may be of most utility in the setting of high disease activity, limited mobility, and/or significant symptoms.
• Intraarticular glucocorticoid injection of the sacroiliac joints as adjunct therapy is conditionally recommended (PICO C.6).	Very low
Physical therapy
• In children and adolescents with sacroiliitis who have or are at risk for functional limitations, using physical therapy is conditionally recommended (PICO C.7).	Very low

^*TNFi = tumor necrosis factor inhibitor (etanercept, adalimumab, infliximab, golimumab) (see Table 3 for other definitions).

^†A bridging course of oral glucocorticoids was defined as a short course (<3 months) of oral glucocorticoids intended to control disease activity quickly during the initiation or escalation of therapy.