Inclusion Criteria:  Males or females age 8 to 21 years  Juvenile SpA diagnosis (symptom onset before their 16th birthday):  Pediatric Rheumatology International Trials Organization (PRINTO) revision of the The International League of Associations for Rheumatology (ILAR) criteria enthesitis/spondylitis-related Juvenile idiopathic arthritis (JIA)  Peripheral arthritis and enthesitis, or Arthritis or enthesitis, plus ≥ 3 months of inflammatory back pain and sacroiliitis on imaging, or Arthritis or enthesitis plus 2 of the following: (1) sacroiliac joint tenderness; (2) inflammatory back pain; (3) presence of Human leukocyte antigen (HLA-B27) ; (4) acute (symptomatic) anterior uveitis; and (5) history of a SpA in a first-degree relative Currently taking one of the following TNFi therapies (Adalimumab, Certolizumab, Etanercept, Golimumab, Infliximab) at standard doses and dosing intervals Have reached a clinically inactive disease state for a minimum of six months, as determined by treating physician English speaking Interested and willing to de-escalate TNFi therapy  Exclusion Criteria:  1) No history of uveitis, psoriasis, or inflammatory bowel disease