In our treatment of JIA, we often initially start with NSAID (e.g. naproxen) and may use corticosteroid joint injections for a few large joints. If this allows patients to achieve remission, then typically a disease modifying anti-rheumatic drug (DMARD) such as methotrexate is not required. However, if there is any residual disease activity after NSAID and injections (for example, in small finger or toe joints, or jaw [TMJ]) then a DMARD would be indicated. Also, if the joint injections don’t have a lasting effect, a DMARD may be beneficial. An advantage of using a DMARD is that it can also help to prevent additional joints from becoming affected by arthritis, and prevent joint damage in the long term.