TNF and juvenile idiopathic arthritis: Prompt escalation to tumor necrosis factor inhibitors (TNFis) is recommended for juvenile idiopathic arthritis (JIA) refractory to disease-modifying antirheumatic drugs (DMARDs).1 Increasingly, TNFis are used as first-line therapy, and early treatment may be associated with better outcomes.2 Although insurance is associated with treatment delays in adults with rheumatoid arthritis,3,4 it is unknown if prior authorization (PA) requirements delay TNFi initiation among children with JIA.