Table 6.

Recommendations for the Initial and Subsequent Treatment of Children and Adolescents with JIA and Enthesitis^*

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

^*TNFi = tumor necrosis factor alpha inhibitor (etanercept, adalimumab, infliximab, golimumab).

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