Fig. 1

Therapeutic algorithm with 4 equally applicable consensus treatment plans. Initial treatment with methotrexate is intended for all patients with the diagnosis of polyarticular JIA. Non-steroidal-antiinflammatory drugs (NSAID) and up to 4 intraarticular joint injections with Triamcinolone hexacetonid are facultative on the discretion of the physician. Efficacy and tolerability should be evaluated every 3 months. The existing therapy will be continued if the therapeutic goals have been achieved, but should be altered if these have not been achieved. The treatment goals formulated for month 3, 6, 9 and 12 become more stringent with duration of therapy. The selection of the biologics is the responsibility of the treating physician. The approval for age and weight should be considered. ABA = abatacept, ADA = adalimumab, ETA = etanercept, GOL = golimumab, TOC = tocilizumab