Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct;77(10):1433-1441.
doi: 10.1002/art.43216. Epub 2025 Jul 7.

Three-Year Outcomes and Latent Class Trajectory Analysis of the Childhood Arthritis and Rheumatology Research Alliance Polyarticular JIA Consensus Treatment Plans Study

Sarah Ringold  1 , Mei-Sing Ong  2 , George Tomlinson  3 , Marc D Natter  2 , Laura E Schanberg  4 , Vincent Del Gaizo  5 , Brian M Feldman  6 , Katherine L Murphy  5 , Yukiko Kimura  7 ; CARRA Registry STOP‐JIA Investigators
Collaborators, Affiliations

Three-Year Outcomes and Latent Class Trajectory Analysis of the Childhood Arthritis and Rheumatology Research Alliance Polyarticular JIA Consensus Treatment Plans Study

Sarah Ringold et al. Arthritis Rheumatol. 2025 Oct.

Abstract

Objective: To assess the impact of differences in the timing of initial biologic disease-modifying antirheumatic drug (bDMARD) therapy using the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Start Time Optimization of biologics in Polyarticular Juvenile Idiopathic Arthritis (JIA) (STOP-JIA) - consensus treatment plans study on outcomes through three years.

Methods: Start Time Optimization of biologics in Polyarticular-JIA participants with CARRA Registry follow-up through three years were eligible. Outcomes included American College of Rheumatology clinically inactive disease (CID) off glucocorticoids, clinical Juvenile Arthritis Disease Activity Score based on 10 joints inactive disease (cJADAS-10-ID) (cJADAS-10-ID: cJADAS-10 ≤ 2.5), clinical remission on medication (CRM), and proportion of time in CID and/or cJADAS-10-ID. Latent class trajectory modeling (LCTM) was applied to identify participant subgroups sharing similar disease courses over this period.

Results: A total of 297 participants were included (n = 190 step-up [SU], 76 early combination [EC], and 31 biologic first). At the three-year visit, CID was achieved by 35%, 42%, and 44%, respectively (P = 0.35 for SU versus EC). EC was superior to SU in achieving CRM (59.9% vs 40.6%; P = 0.012), time spent in CID (38% versus 30%; P = 0.04), and cJADAS-10-ID (51% versus 41%; P = 0.02). Slow, moderate, and rapid improvement trajectories were identified by LCTM; bDMARD initiation within the first (odds ratio [OR] 5.33) or second (OR 2.67) month from baseline was associated with the rapid improvement trajectory.

Conclusion: EC was superior to SU across three years for outcomes reflecting time spent in lower disease activity. Starting bDMARD within two months predicted rapid improvement and maintenance of inactive disease. These results support the hypothesis that early bDMARD initiation reduces overall disease burden in pJIA.

PubMed Disclaimer

References

REFERENCES

    1. Wallace CA, Huang B, Bandeira M, et al. Patterns of clinical remission in select categories of juvenile idiopathic arthritis. Arthritis Rheum 2005;52(11):3554–3562.
    1. Ringold S, Seidel KD, Koepsell TD, et al. Inactive disease in polyarticular juvenile idiopathic arthritis: current patterns and associations. Rheumatology (Oxford) 2009;48(8):972–977.
    1. Wallace CA, Giannini EH, Huang B, et al; Childhood Arthritis Rheumatology Research Alliance; Pediatric Rheumatology Collaborative Study Group; Paediatric Rheumatology International Trials Organisation. American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2011;63(7):929–936.
    1. Mannion ML, Xie F, Beukelman T; CARRA Registry Investigators. Investigation of inactive disease states among patients with juvenile idiopathic arthritis in the Childhood Arthritis and Rheumatology Research Alliance registry. ACR Open Rheumatol 2022;4(9):825–831.
    1. Kimura Y, Schanberg LE, Tomlinson GA, et al; CARRA STOP‐JIA Investigators. Optimizing the start time of biologics in polyarticular juvenile idiopathic arthritis: a comparative effectiveness study of Childhood Arthritis and Rheumatology Research Alliance consensus treatment plans. Arthritis Rheumatol 2021;73(10):1898–1909.

LinkOut - more resources