Therapeutic options in psoriatic juvenile idiopathic arthritis

Triamcinolone acetonide: 0.5 to 2 mg/kg intraarticularly, up to 80 mg depending on size of joint (range: 5 to 80 mg)

Effective only for treatment of the joint that is injected. It is unusual to inject more than 3 to 4 joints at one time.

Triamcinolone is the most effective glucocorticoid for joint injections but is not used for soft tissue injections.

Intra-articular injections: 1 mg/kg, up to 80 mg depending upon size of joint or lesion (range: 5 to 80 mg)

• 10 to 25 kg: 50 mg orally twice daily
• >25 kg: 100 mg orally twice daily or 200 mg once daily

Adult dosing: 200 mg orally once to twice daily

• 10 to 15 mg/m²/dose once weekly or 0.5 to 1 mg/kg/dose once weekly (maximum 25 mg per week)

Administer with folic acid 0.4 to 1 mg orally once daily or leucovorin 2.5 to 5 mg orally once weekly on day after methotrexate dose

Not effective for the treatment of axial arthritis^Δ.

• <20 kg: 10 mg orally every other day
• 20 to 40 kg: 10 mg orally once daily
• >40 kg: 20 mg orally once daily

• <30 kg: 162 mg SUBQ once every 3 weeks
• ≥30 kg: 162 mg SUBQ once every 2 weeks

Intravenous administration (dose based on patient weight):

• <30 kg: 10 mg/kg/dose IV once every 4 weeks
• ≥30 kg: 8 mg/kg/dose IV once every 4 weeks (maximum 800 mg/dose)

• 10 to <15 kg: 10 mg SUBQ once every 2 weeks (may escalate to weekly for partial response)
• 15 to 30 kg: 20 mg SUBQ once every 2 weeks (may escalate to weekly for partial response)
• ≥30 kg: 40 mg SUBQ once every 2 weeks (may escalate to weekly for partial response)

• Pediatric dosing (dose based on body surface area): 80 mg/m²/dose IV at weeks 0 and 4, then every 8 weeks (maximum 240 mg/dose)
• Adult dosing (dose based on patient weight): 2 mg/kg/dose IV at weeks 0 and 4, then every 8 weeks (no defined maximum dose)

Subcutaneous administration (no pediatric indication): 50 mg SUBQ once monthly

• 10 to <20 kg: 100 mg SUBQ at weeks 0, 2, and 4, then 50 mg SUBQ once every 2 weeks
• 20 to <40 kg: 200 mg SUBQ at weeks 0, 2, and 4, then 100 mg SUBQ once every 2 weeks
• ≥40 kg: 400 mg SUBQ at weeks 0, 2, and 4, then 200 mg SUBQ once every 2 weeks

Administer SUBQ at weeks 0, 1, 2, 3, 4, then every 4 weeks

• 15 to <50 kg: 75 mg/dose
• ≥50 kg: 150 mg/dose

Administer SUBQ at weeks 0 and 4, then every 12 weeks

• <60 kg: 0.75 mg/kg/dose
• ≥60 kg: 45 mg/dose
• Patients >100 kg with moderate to severe plaque psoriasis: 90 mg/dose

May not be as effective for axial arthritis^§.

• 10 to <25 kg: 50 mg SUBQ once weekly
• 25 to 50 kg: 87.5 mg SUBQ once weekly
• ≥50 kg: 125 mg SUBQ once weekly

• 10 to <20 kg: 3.2 mg orally twice daily
• 20 to <40 kg: 4 mg orally twice daily
• ≥40 kg: 5 mg orally twice daily (alternative: 11 mg extended-release tablet orally once daily)

• 10 to <20 kg: 3 mg orally twice daily
• 20 to <30 kg: 4 mg orally twice daily
• ≥30 kg: 6 mg orally twice daily (alternative: 15 mg extended-release tablet orally once daily)

• 2 to <9 years: 2 mg orally once daily
• ≥9 years: 4 mg orally once daily

Dose based on patient weight:

• 10 to <30 kg: 2 mg orally once daily
• ≥30 kg: 4 mg orally once daily

• 20 to <50 kg: 20 mg orally twice daily (begin at 10 mg once daily and increase over 4 days to achieve target dose)
• ≥50 kg: 30 mg orally twice daily (begin at 10 mg once daily and increase over 6 days to achieve target dose)

Use in psJIA is off-label; dosing is based on approved dosing for moderate to severe plaque psoriasis.