If disease activity is low, however, the doctor may continue to watch the disease for six months before moving onto methotrexate. If methotrexate fails to control the disease after a few months, your child’s doctor will likely recommend an anti-TNF agent.

If, after four months or so,TNF agents are not effective, your doctor may switch to another biologic agent such as abatacept (Orencia) with a different mode of action.

“The idea then is to shut off the disease as quickly as possible with as aggressive a therapy as you need to,” says Giannini.


The treatment for systemic disease is often more complicated than oligoarticular or polyarticular disease because children with systemic JIA essentially have two diseases: joint disease and systemic disease, says Dr. Kimura. “You have to look at the two different parts and treat to ameliorate the symptoms of each of those.”

For mild disease with few involved joints and the absence of serious systemic manifestations, such as pericarditis (inflammation of the pericardium, the sac-like covering around the heart), doctors often begin treatment with an NSAID. If the systemic disease is active, your child’s doctor may begin treatment with an oral corticosteroid such as prednisone to get inflammation quickly under control.

If corticosteroids alone fail to control disease activity, the doctor may that prescribe one of two biologic agents: anakinra (Kineret), which blocks a protein called interleukin 1(IL-1), or tocilizumab (Actemra), which blocks interleukin 6 (IL-6).

“It all depends on how they do and how long you are willing to stick with therapy before escalating to the next level,” says Giannini. “Also, if you go to a biologic, you may still use steroids and NSAIDs if you need them.”

If your child has active arthritis, her doctor may prescribe methotrexate or an anti-TNF agent; however, doctors never prescribe two biologics together due to their prohibitive cost and the possibility of complications, says Giannini.