THE NEW systemic juvenile idiopathic arthritis (JIA) recommendations outline evidence-based treatment strategies that prioritize early pathway inhibition and careful glucocorticoid use.
Evidence-Based Framework for Systemic JIA Care
An expert panel of pediatric rheumatologists across Latin America collaborated to create updated, evidence-based treatment recommendations for systemic JIA. Using the PICO framework and Grading of Recommendations Assessment, Development, and Evaluation methodology, the panel evaluated pharmacologic strategies for both major systemic JIA phenotypes. The resulting guidance is designed to support clinicians in selecting therapies informed by robust evidence and multidisciplinary consensus.
Systemic JIA Treatment Recommendations
The recommendations focus on the two most common clinical presentations: systemic JIA with predominantly systemic features and systemic JIA with predominantly active synovitis. Across both phenotypes, early initiation of IL-1 or IL-6 pathway inhibition is emphasized as the optimal therapeutic strategy. A short course of corticosteroids may be added, but the expert panel highlights the importance of minimizing cumulative steroid exposure. For patients with systemic features and high disease activity, high-dose intravenous methylprednisolone pulse therapy is advised to gain early control.
Glucocorticoid Minimization and Tapering Strategies
A central component of these systemic JIA recommendations is the need to limit glucocorticoid therapy. The expert panel underscores that corticosteroids should be used at the lowest effective dose and for the shortest feasible duration. Gradual tapering is advised, with discontinuation targeted within a maximum of six months. This approach aims to reduce long-term complications while maintaining adequate disease control.
Clinical Implications for Practice
These systemic JIA treatment recommendations offer clinicians a structured approach to phenotype-specific care. Early targeted therapy, limited steroid exposure, and clearly defined escalation strategies equip providers with practical guidance to improve treatment consistency and outcomes. The recommendations also reinforce the value of multidisciplinary collaboration and rigorous evidence synthesis in shaping contemporary systemic JIA management.
Reference: Franco L et al. Pan American League of Associations for Rheumatology treatment recommendations for systemic juvenile idiopathic arthritis. Rheumatol Adv Pract. 2025;9(4):rkaf087.
