TOPLINE:

Starting biologic therapy within 6 months of symptom onset in children with nonsystemic juvenile idiopathic arthritis (JIA) was associated with a significantly higher proportion who achieved inactive arthritis at 6 months.

METHODOLOGY:

• Researchers conducted a nested cohort study across Canada and Netherlands between April 2019 and November 2024 to assess whether the timing of starting biologic therapy after symptom onset affected treatment outcomes in JIA.
• They included 130 children with nonsystemic JIA who were naive to biologics before starting biologic therapy within 24 months of symptom onset (median age at symptom onset, 11 years; 66% girls).
• Of them, 35 patients initiated biologic treatment within 0-6 months after symptom onset (early), 46 initiated within 7-12 months (intermediate), and 49 initiated within 13-24 months (late).
• Active joint count was assessed across 83 joints; a joint was considered active if it was swollen or had both signs of tenderness and was limited in range of motion.
• The outcome was inactive arthritis, defined as having an active joint count of zero at 6 months after initiating biologic therapy.

TAKEAWAY:

• Among patients who started biologic therapy early, 83% achieved inactive arthritis compared with only 57% of those who started it late (P = .013).
• Each month of delay in initiating biologic therapy was associated with a 9% increase in the odds of having active arthritis at 6 months (adjusted odds ratio, 1.09; 95% CI, 1.02-1.17).
• TNF inhibitors were the predominant biologic used across all treatment groups (97%).

IN PRACTICE:

“[The study] results suggest a window of opportunity to control nonsystemic JIA when the biologic therapy is initiated early after symptom onset,” the authors of the study wrote.

“The treatment of JIA patients will be improved when patients who are in need of biologics could start early with biologic treatment without losing time on other treatment strategies first,” they added.

SOURCE:

This study was led by Jelleke B. de Jonge and Sytze de Roock, PhD, both from University Medical Center Utrecht, Utrecht, Netherlands. It was published online on September 22, 2025, in Arthritis & Rheumatology.

LIMITATIONS:

More severe JIA cases may have been overrepresented among those who started biologics early. The analysis adjusted for prior exposure to conventional synthetic disease-modifying antirheumatic drugs but did not consider the duration of treatment or the time taken to escalate to biologics.

DISCLOSURES:

This study received support from multiple sources in Canada and Netherlands including the Canadian Institutes of Health Research, Genome Canada, and the Dutch Arthritis Foundation. Several authors reported receiving grants, consulting and speaking fees, and having other ties with multiple organizations including Novartis, Pfizer, and Sobi.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.