Influence of the timing of biological treatment initiation on Juvenile Idiopathic Arthritis long-term outcomes

Filipa Oliveira Ramos, Ana Maria Rodrigues, Ana Teresa Melo, Francisca Aguiar, Luísa Brites, Soraia Azevedo, Ana Catarina Duarte, José António Melo Gomes, Carolina Furtado, Ana Filipa Mourão, Graça Sequeira, Inês Cunha, Ricardo Figueira, Maria José Santos, João Eurico Fonseca

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Background: Juvenile idiopathic arthritis (JIA) treatment is aimed at inducing remission to prevent joint destruction and disability. However, it is unclear what is the long-term impact on health-related outcomes of the timing of biological disease-modifying antirheumatic drug (bDMARD) initiation in JIA. Our aim was to evaluate the long-term impact of the time between JIA onset and the initiation of a bDMARD in achieving clinical remission, on physical disability and health-related quality of life (HRQoL). Methods: Adult JIA patients registered in the Rheumatic Diseases Portuguese Register ( and ever treated with bDMARD were included. Data regarding socio-demographic, JIA-related characteristics, disease activity, physical disability (HAQ-DI), HRQoL (SF-36), and treatments were collected at the last visit. Patients were divided into 3 groups (≤ 2 years, 2–5 years, or > 5 years), according to the time from disease onset to bDMARD initiation. Regression models were obtained considering remission on/off medication, HAQ-DI, SF-36, and joint surgeries as outcomes and time from disease onset to bDMARD start as an independent variable. Results: Three hundred sixty-one adult JIA patients were evaluated, with a median disease duration of 20.3 years (IQR 12.1; 30.2). 40.4% had active disease, 35.1% were in remission on medication, and 24.4% were in drug-free remission; 71% reported some degree of physical disability. Starting a bDMARD > 5 years after disease onset decreased the chance of achieving remission off medication (OR 0.24; 95% CI 0.06, 0.92; p = 0.038). Patients who started a bDMARD after 5 years of disease onset had a higher HAQ and worse scores in the physical component, vitality, and social function domains of SF-36, and more joint surgeries when compared to an earlier start. Conclusion: Later initiation of bDMARDs in JIA is associated with a greater physical disability, worse HRQoL, and lower chance of drug-free remission in adulthood.

Original languageEnglish
Article number177
JournalArthritis Research and Therapy
Issue number1
Publication statusPublished - 21 Sept 2023


  • bDMARDs
  • Juvenile idiopathic arthritis
  • Long-term outcomes
  • Physical disability
  • Quality of life


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