How would you approach management of a patient with sJIA that was previously well controlled on tocilizumab but is now having ongoing joint disease activity?

Not sure what specifically was the intolerance to methotrexate; I personally only give it subcutaneously (more effective, bypass liver first from GI tract, better and more consistently absorbed, less GI side effects). I really like methotrexate with IL-1 blockade, as a subset of kids with sJIA go on to develop destructive arthritis. If tocilizumab is not working, I like the combination of methotrexate (SC), anakinra (for systemic features), and abatacept (for both arthritis and systemic features...