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Pharmacological treatment patterns in patients with juvenile idiopathic arthritis in the Netherlands: a real-world
Michelle M A Kip1,2, Sytze de Roock2,3, Gillian Currie4,5,6,7
1Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede.
Insights
Pediatric JIA treatment involves diverse therapies and sequences, with remission being the primary reason for discontinuing disease-modifying antirheumatic drugs (DMARDs). This highlights complex medication management in juvenile idiopathic arthritis.
Area of Science:
- Pediatric Rheumatology
- Pharmacology
- Immunology
Background:
- Juvenile idiopathic arthritis (JIA) requires complex, individualized treatment strategies.
- Understanding medication patterns is crucial for optimizing therapeutic outcomes in pediatric patients.
Purpose of the Study:
- To investigate medication prescription patterns in children with JIA.
- To analyze treatment duration, sequence, and reasons for discontinuation.
Main Methods:
- Retrospective analysis of electronic medical records for 236 JIA patients (0-18 years).
- Data collected from April 2011 to March 2019.
- Descriptive statistics, Sankey diagrams, and Kaplan-Meier survival methods were used.
Main Results:
- 20 medicines prescribed as monotherapy or combination therapy over a median 4.2-year follow-up.
- High rates of synthetic and biologic DMARD use, varying by JIA subtype.
- Most patients (56.8%) received multiple treatment lines, with 68 unique sequences identified.
- Remission (44.7%) was the main reason for DMARD discontinuation, followed by adverse events (28.9%) and ineffectiveness (22.1%).
Conclusions:
- Pharmacological treatment for JIA is complex, characterized by diverse therapies and sequences.
- Significant variation in prescriptions exists across JIA subtypes.
- Most patients require multiple treatment lines, underscoring the need for adaptable treatment plans.
Objective:
To investigate medication prescription patterns among children with JIA, including duration, sequence and reasons for medication discontinuation.
Methods:
This study is a single-centre, retrospective analysis of prospective data from the electronic medical records of JIA patients receiving systemic therapy aged 0-18 years between 1 April 2011 and 31 March 2019. Patient characteristics (age, gender, JIA subtype) and medication prescriptions were extracted and analysed using descriptive statistics, Sankey diagrams and Kaplan-Meier survival methods.
Results:
Over a median of 4.2 years follow-up, the 20 different medicines analysed were prescribed as monotherapy (n = 15) or combination therapy (n = 48 unique combinations) among 236 patients. In non-systemic JIA, synthetic DMARDs were prescribed to almost all patients (99.5%), and always included MTX. In contrast, 43.9% of non-systemic JIA patients received a biologic DMARD (mostly adalimumab or etanercept), ranging from 30.9% for oligoarticular persistent ANA-positive JIA, to 90.9% for polyarticular RF-positive JIA. Among systemic JIA, 91.7% received a biologic DMARD (always including anakinra). When analysing medication prescriptions according to their class, 32.6% involved combination therapy. In 56.8% of patients, subsequent treatment lines were initiated after unsuccessful first-line treatment, resulting in 68 unique sequences. Remission was the most common reason for DMARD discontinuation (44.7%), followed by adverse events (28.9%) and ineffectiveness (22.1%).
Conclusion:
This paper reveals the complexity of pharmacological treatment in JIA, as indicated by: the variety of mono- and combination therapies prescribed, substantial variation in medication prescriptions between subtypes, most patients receiving two or more treatment lines, and the large number of unique treatment sequences.
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