Dosing of Steroids in Systemic Juvenile Idiopathic Arthritis (sJIA)

 Glucocorticoids

• used judiciously in sJIA to minimize toxicity.
• typically used during acute phase of the illness to preserve the ability to carry out activities of daily living, particularly in children who have not responded quickly to initial therapy.
• Every effort must be made to minimize the dose and duration of therapy. Whenever possible, the dose should be kept below 0.5 mg/kg per day of prednisone (or its equivalent), and the duration of therapy should be less than six months.
• A disease-modifying agent more appropriate for long-term management should be initiated soon after the child is stabilized in order to facilitate the timely withdrawal of glucocorticoids.
• Some clinicians use intermittent high-dose intravenous glucocorticoids to reduce the toxicity associated with daily oral glucocorticoids or to treat severe anaemia or pericarditis.

Reference

1. Dewitt EM, Kimura Y, Beukelman T, Nigrovic PA, Onel K, Prahalad S, Schneider R, Stoll ML, Angeles‐Han S, Milojevic D, Schikler KN. Consensus treatment plans for new‐onset systemic juvenile idiopathic arthritis. Arthritis care & research. 2012 Jul 1;64(7):1001-10.
2. www.uptodate.com