PhD research by Martijn Doeleman (UMC Utrecht) has shown that treatment and monitoring in juvenile idiopathic arthritis can be further improved and tailored to the individual patient. These would benefit from more personalized treatment where individual prediction of response to therapy, patient preferences, and risk factors are considered in the choice of medication. In addition, digital solutions may assist with disease monitoring, identification of trends, and communication with physicians.
Juvenile idiopathic arthritis (JIA) is an umbrella term for diseases characterized by arthritis with unknown etiology in children. The clinical presentation of JIA is heterogeneous, ranging from mild inflammation in a single joint to severe inflammation in multiple joints with accompanying systemic inflammation. Although frequent monitoring is an important hallmark of current treatment strategies for JIA, a disadvantage of traditional monitoring is the requirement of face-to-face physical appointments. This results in absence from school and work, travel costs, and increases the burden on the healthcare system. Over the last 20 years, treatment of JIA has improved drastically due to new potent drugs, more clinical trials, and international guidelines. Although guidelines have improved standardization of JIA care, guidance on which specific agent to use for each individual patient is difficult due to a lack of data and heterogeneity of the disease. The PhD thesis of Martijn Doeleman, MD (Department of Pediatric Immunology and Rheumatology, UMC Utrecht) explored advancements in monitoring and treatment strategies for JIA, with the aim to improve personalized care.
Remote monitoring
In his thesis Martijn Doeleman investigated novel monitoring strategies, including the feasibility of capillary blood sampling at home as an alternative to venous blood draws at the hospital. Results of this study provided insights into the feasibility and challenges associated with self-sampling. It was shown that results from capillary and venous blood samples were comparable, supporting its potential in remote monitoring. In other studies in JIA patients, a mobile eHealth application and web-based surveys were examined, demonstrating that these technologies could be used as remote monitoring tools, especially for patients with stable or inactive disease.
Personalized treatment
This thesis also presented research to further improve and tailor JIA treatment. Potential causes for therapy failure of biologicals, including the formation of anti-drug antibodies and low drug levels, were discussed. The thesis also examined biologic therapy withdrawal, showing that stopping specific biologicals in JIA patients with clinically inactive disease leads to significant cost reductions. Furthermore, the development of prediction models for methotrexate response was explored, which remains the first-line treatment agent for non-systemic JIA.
Martijn Doeleman concludes: “My thesis elaborates on current research challenges and provides new evidence towards a data-driven and personalized approach to monitoring and treatment strategies, integrating remote monitoring, predictive models, and cost-effective treatment adjustments to further personalize and improve care for children with JIA.”
“My thesis elaborates on current research challenges and provides new evidence towards a data-driven and personalized approach to monitoring and treatment strategies, integrating remote monitoring, predictive models, and cost-effective treatment adjustments to further personalize and improve care for children with JIA.”
PhD defense
Martijn Doeleman, MD (1994, Utrecht) defended his PhD thesis on May 20, 2025 at Utrecht University. The title of his thesis was “Towards a Continuum of Care for Juvenile Idiopathic Arthritis – Innovative strategies regarding monitoring and treatment”. Supervisor was em. prof. Nico Wulffraat, MD, PhD (Department of Pediatric Immunology and Rheumatology, UMC Utrecht) Co-supervisors were Sytze de Roock, MD, PhD and Joost Swart, MD, PhD (both Department of Pediatric Immunology and Rheumatology, UMC Utrecht). Martijn works as an ICT consultant and software developer at UMC Utrecht where he contributes to innovative strategies to improve clinical care and research quality.
