{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T19:47:46Z","timestamp":1774554466377,"version":"3.50.1"},"reference-count":17,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T00:00:00Z","timestamp":1633564800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Increasing evidence supports the conclusion that early initiation of biologics may dramatically improve disease course and reduce glucocorticoid exposure for children with systemic juvenile idiopathic arthritis (JIA). The present study was undertaken to characterize variation in the use of first\u2010line biologic and glucocorticoid therapy and to identify drivers of variation in children hospitalized with new\u2010onset systemic JIA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study of children hospitalized with new\u2010onset systemic JIA from 2008 to 2019 utilizing a comparative pediatric database from 52 tertiary care children\u2019s hospitals. Subjects and treatment receipt were identified using International Classification of Diseases, Ninth Revision (ICD\u20109) and ICD\u201010 discharge diagnosis codes, pharmacy billing data, and clinical transaction classification codes. Mixed\u2010effects logistic regression was used to identify patient\u2010 and hospital\u2010level factors associated with receipt of glucocorticoids and biologics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 534 children with new\u2010onset systemic JIA hospitalized during the study period met inclusion criteria. Twenty\u2010nine percent received biologics, and 58% received glucocorticoids. Biologic use increased over time (<jats:italic>P<\/jats:italic> &lt; 0.001), methotrexate use decreased (<jats:italic>P<\/jats:italic> &lt; 0.01), and glucocorticoid use remained unchanged. Biologics and glucocorticoid use varied significantly between hospitals. High annual hospital volume, intensive care unit stay, and later discharge year were significantly associated with biologic exposure. Medium\u2010high and high annual hospital volume were significantly associated with less glucocorticoid exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite increasing evidence demonstrating improved outcomes with first\u2010line treatment with biologics, we found significant treatment variation across hospitals with many children not receiving biologics and a persistent high rate of glucocorticoid exposure. These results underscore the need for comparative efficacy studies and improved treatment standardization.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24417","type":"journal-article","created":{"date-parts":[[2020,8,16]],"date-time":"2020-08-16T09:34:58Z","timestamp":1597570498000},"page":"1714-1721","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Variation in Treatment of Children Hospitalized With New\u2010Onset Systemic Juvenile Idiopathic Arthritis in the US"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0959-2343","authenticated-orcid":false,"given":"Rosemary G.","family":"Peterson","sequence":"first","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Xiao","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Philadelphia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen E.","family":"James","sequence":"additional","affiliation":[{"name":"University of Utah Primary Children\u2019s Hospital Salt Lake City"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Katcoff","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian T.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia and University of Pennsylvania Philadelphia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela F.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia and University of Pennsylvania Philadelphia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,10,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.12703\/P6-21"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1205099"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1112802"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21625"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.40865"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.34661"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.150997"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.39796"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.85.5.421"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-018-4297-6"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20050473"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar1826"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.20944"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60454-7"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38092"},{"key":"e_1_2_6_17_1","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1136\/annrheumdis-2019-eular.5107","article-title":"Op0057 Early treatment with anakinra in systemic juvenile idiopathic arthritis","volume":"78","author":"Pardeo M","year":"2019","journal-title":"Ann Rheum Dis"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12969-017-0157-1"}],"container-title":["Arthritis Care &amp; 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