Table 2.

Biological agents approved or currently under study for JPI sA.

Biologic agent	Target	Role in pathogenesis	Availability for JPsA
Etanercept	TNF alpha	Proinflammatory cytokine, found elevated in skin and synovial fluid in psoriasis and PsA (19).	Approved by FDA and EMA for JPsA ≥12 year-old patient.
Tofacitinib	JAK1 JAK3	JAK/STAT pathway is involved in the inflammatory cascade induced by several cytokines, including IL-12, IL-23, TNF alpha.	Approved by FDA and EMA for JPsA ≥2 year-old patients.
Secukinumab/ Ixekizumab	IL-17A	Main proinflammatory cytokine produced by Th17 lymphocytes, which plays a crucial role in skin and synovium inflammation in PsA (23, 40).	Secukinumab: ongoing phase III study for active JPsA or ERA.
			Ixekizumab: approved for juvenile plaque psoriasis. Currently under investigation for juvenile SPA
Ustekinumab	P40 subunit of IL-12 and IL-23	IL-23 induces differentiation of Th17 cells and production of IL-17, main pathogenic cytokine in PsA (19, 35).	Ongoing trial for juvenile refractory psoriasis in adolescents. No prospective studies for JPsA.
Guselkumab/ Rizankizumab	IL-23	IL-23 induces differentiation of Th17 cells and production of IL-17, main pathogenic cytokine in PsA (19, 35).	Approved by FDA and EMA for adult psoriasis and PsA. Ongoing trials for pediatric psoriasis.

PsA, psoriatic arthritis; JPsA, juvenile psoriatic arthritis; IL, interleukin; JAK, janus kinase; STAT, signal transducer and activator of transcription; TNF, tumor necrosis factor; ERA, enthesitis–related arthritis; SPA, spondyloarthropathy; FDA, Food and Drug Administration; EMA, European Medicines Agency.