For a pediatric patient with juvenile spondyloarthropathy with partial response, though ongoing axial disease, on a JAKi, would you increase the dose of JAKi, add methotrexate, or switch to alternate therapy like IL-17 inhibition?

Let me first disclose that I am not a pediatric rheumatologist and would defer to one.

Have NSAIDs been tried and optimized? If not, that is the best first option.

In general, optimizing the dose of a medication that seems to be working is a great choice. However, I do not know what current dosage i...

I would stop JAKi and switch to a different therapy such as IL-17 inhibition as methotrexate is not effective for axial disease.