Children with juvenile idiopathic arthritis respond significantly better to treatment when biologic therapy is started soon after the first symptoms appear. A new international cohort study by Dutch and Canadian investigators which was analyzed by Jelleke de Jonge (UMC Utrecht) shows that each month of delay reduces the chance of achieving inactive arthritis within six months.
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and can lead to long-term disability. Current treatment guidelines often follow a so-called step-up approach: starting with cheaper but less effective drugs such as methotrexate (MTX) and introducing biologic therapy only when MTX fails. Although biologics have proven to be highly effective, the current approach implicates that many children only receive biologic therapy after months or even years of trial and error. For this study, Jelleke de Jonge investigated whether the time between symptom onset and the start of biologic therapy may affect treatment success. As published this week in Arthritis & Rheumatology, they analyzed data from 130 children with non-systemic JIA who started biologic therapy for the first time. Participants were grouped based on how quickly they started treatment with a biologic since onset of symptoms: 35 patients within six months (‘early’), 46 patients within 7–12 months (‘intermediate’), and 49 patients within 13–24 months (‘late’) after that symptoms began. Although the patients differed in how quickly they started biologic therapy, no significant differences were found between these groups at their diagnosis visit in the hospital.
Jelleke de Jonge
The results of the study were striking. Among early starters with biologics, 83 percent of patients achieved inactive arthritis within six months. In contrast, only 57 percent of those who started treatment late reached the same outcome. Further analysis confirmed that each month of delay of starting biologics increased the chance of still having active arthritis by 9 percent. These findings suggest the existence of a ‘window of opportunity’ in JIA. This is considered a period soon after symptom onset during which treatment is most effective. Starting biologics early appears to halt disease progression.
“Our data show that timing matters,” concludes PhD candidate and first author of the paper Jelleke de Jonge, MSc from the Department of Pediatric Rheumatology at Wilhelmina’s Children’s Hospital (part of UMC Utrecht). “When biologic therapy is started early, children have a greater chance of achieving inactive disease quickly.”
The study provides real-world evidence supporting a shift in clinical practice toward earlier use of biologics in non-systemic JIA. While more research is needed to understand the long-term effects, the message is clear: delays in starting biologic treatment can reduce the likelihood of remission and prolong disease activity. By identifying this critical treatment window, the study could spark a discussion about whether the current treatment guidelines might need adaptation. Such an update might result in a faster, more targeted care, giving children with arthritis a better chance at lasting relief and improved quality of life.
Biologic therapies for JIA target specific parts of the immune system to reduce inflammation and are powerful alternatives to conventional medications such as methotrexate. Common biologics approved for JIA include etanercept, adalimumab and tocilizumab. These biologics have now lost patent protection and are now available at approximately 10-20 percent of the original price in the Netherlands. Long-term biologic therapy for JIA is generally considered effective and well-tolerated.
This is the first clinical paper of the UCAN CAN-DU (Canada–Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases) project which is coordinated by Joost Swart, MD, PhD, Bas Vastert, MD PhD (both UMC Utrecht, the Netherlands), Prof. Rae Yeung, MD PhD (University of Toronto, Canada) and Prof. Susa Benseler, MD PhD (University of Calgary, Canada). This project, supported by ZonMw, ReumaNederland and the Canadian Institute of Health research (CIHR), in which Dutch and Canadian researchers collaborate, has since its inception in 2018 collected extensive clinical, biological, health economy data and patient reported outcomes of more than 2,000 children with JIA.
De Jonge JB, De Roock S, Schonenberg-Meinema D, Van den Berg JM, Marshall DA, Vastert SJ, Yeung RSM, Swart JF*, Benseler SM*, on behalf of the UCAN CAN-DU and UCAN CURE consortia. Effect of time to start of biologic therapy on treatment response in childhood arthritis: results from the UCAN CAN-DU cohort. Arthritis Rheumatol 2025 Sep 22. doi: 10.1002/art.43401
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