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JAK-inhibitors are small molecules blocking the JAK-STAT pathway that have proven effective in the treatment of different immune-mediated diseases in adults and juvenile idiopathic arthritis (JIA)., Aim of Study: To evaluate the safety and efficacy of tofacitinib in children with different rheumatic diseases., Material and Methods: We extracted information from 24 children with the following diagnosis: JIA ( n = 15), undifferentiated systemic autoinflammatory diseases (SAIDs) ( n = 7), and juvenile dermatomyositis (JDM) ( n = 2) who have been treated with tofacitinib for a period of longer than 6 months. The treatment outcomes were classified according to the opinion of the attending physicians as having a complete response (CR), i.e., the absence of disease activity, or a partial response (PR)-a significant improvement of symptoms and disease activity, or no response (NR)-no changes in disease activity., Results: CR was achieved in 10/24 patients; 7/15 among JIA patients, 1/2 among JDM patients, 4/7 among SAID patients, and PR in 5/15 of JIA, 1/2 of JDM, and 3/7 of SAID patients. Three non-responders with JIA discontinued tofacitinib. Corticosteroids were successfully tapered off in 11/14 patients and discontinued in 2/14 patients. Four patients had side effects not requiring treatment discontinuation: liver enzyme elevation ( n = 2), hypercholesterolemia ( n = 1), lymphadenitis ( n = 1)., Conclusion: JAK-inhibitors are effective new therapies for the treatment of multiple immune-mediated diseases. Our experience has shown the best results in patients with JIA and JIA-associated alopecia, and type I interferonopathies. More data from randomized controlled clinical trials are needed to use JAK-inhibitors safely in pediatric rheumatic diseases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kostik, Raupov, Suspitsin, Isupova, Gaidar, Gabrusskaya, Kaneva, Snegireva, Likhacheva, Miulkidzhan, Kosmin, Tumakova, Masalova, Dubko, Kalashnikova, Aksentijevich and Chasnyk.)