A treat-to-target approach using recombinant IL-1 receptor antagonist (rIL-1Ra; anakinra) as a first-line monotherapy in newly diagnosed patients with systemic juvenile idiopathic arthritis (sJIA; n = 42) resulted in inactive disease in 95% of patients and inactive disease (off medication) in 73% of patients at 5 years follow-up. The treat-to-target strategy involved rapidly stepping up the dose of rIL-1Ra from 2 mg/kg/day to 4 mg/kg/day if fever persisted 3 days after starting therapy, followed by the addition of glucocorticoids and/or switching to an alternative therapy if disease persisted.