Table 6.

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

Recommendation	Level of evidence
Initial treatment
In children and adolescents with active enthesitis, NSAID treatment is strongly recommended over no treatment with an NSAID (PICO D.1).	Very low
New heading
In children and adolescents with active enthesitis despite treatment with NSAIDs:
• Using a TNFi is conditionally recommended over methotrexate or sulfasalazine (PICO D.2, D.3).	Low
• Bridging therapy with a limited course of oral glucocorticoids (<3 months) during initiation or escalation of therapy is conditionally recommended (PICO D.4).†	Very low
Bridging therapy may be of most utility in the setting of high disease activity, limited mobility, and/or significant symptoms.
Physical therapy	Very low
• In children and adolescents with enthesitis who have or are at risk for functional limitations, using physical therapy is conditionally recommended (PICO D.5).

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

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