{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T15:07:01Z","timestamp":1769094421369,"version":"3.49.0"},"reference-count":25,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T00:00:00Z","timestamp":1580428800000},"content-version":"unspecified","delay-in-days":30,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Center for Advancing Translational Sciences of the National Institutes of Health","award":["5UL1TR001425-03"],"award-info":[{"award-number":["5UL1TR001425-03"]}]},{"DOI":"10.13039\/100006093","name":"Patient Centered Outcome Research Institute","doi-asserted-by":"crossref","award":["PCORI ME-1408-19894"],"award-info":[{"award-number":["PCORI ME-1408-19894"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2019,12,20]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To compare real-world effectiveness of two adaptive treatment strategies of disease-modifying antirheumatic drugs (DMARDs) in treating children with newly diagnosed polyarticular course juvenile idiopathic arthritis (pcJIA): early aggressive use of biologic DMARDs (bDMARDs) in combination with conventional synthetic DMARDs (csDMARDs) versus conservative delayed use of bDMARDs following the initial csDMARD prescription.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A single-centre newly diagnosed DMARD-naive pcJIA patient database (n=465) was derived from the electronic medical records between 1 January 2009 and 31 December 2018. The primary study endpoints were clinical Juvenile Arthritis Disease Activity Score (cJADAS) at 6 and 12 months following the first DMARD prescription. The secondary study endpoint was Pediatric Quality of Life Inventory (PedsQL) generic total score at 12 months. Averaged causal treatment effects were assessed using a Bayesian non-parametric casual inference method.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Both cJADAS and PedsQL improve over time, regardless of the treatment strategies. Compared with the conservative approach, early aggressive approach is more effective in reducing cJADAS (mean \u22122.17, 95%\u2009CI \u22123.77 to \u22120.56) by 6 months. Adding bDMARD after 6\u2009months to the initial treatment provides very little added benefit. The averaged treatment effect was 6.35 (95% CI \u22125.89 to 18.58) improvement in PedsQL at 12 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Timing matters\u2014early aggressive use with bDMARDs is more effective than conservative delayed treatment in lowering disease activity after 6 and 12 months of treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2019-001091","type":"journal-article","created":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T04:44:20Z","timestamp":1580705060000},"page":"e001091","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Timing matters: real-world effectiveness of early combination of biologic and conventional synthetic disease-modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritis"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9724-675X","authenticated-orcid":false,"given":"Bin","family":"Huang","sequence":"first","affiliation":[{"name":"Division of Biostatistics and Epidemiology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio, USA"},{"name":"Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tingting","family":"Qiu","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Seid","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA"},{"name":"Division of Pulmonary Medicine, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Lovell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA"},{"name":"Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hermine I","family":"Brunner","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA"},{"name":"Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esi M","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA"},{"name":"Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,2,2]]},"reference":[{"key":"2025090313002177000_6.1.e001091.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2013.09.003"},{"key":"2025090313002177000_6.1.e001091.2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12969-017-0160-6","article-title":"The new Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry: design, rationale, and characteristics of patients enrolled in the first 12 months","volume":"15","author":"Beukelman","year":"2017","journal-title":"Pediatr Rheumatol Online J"},{"key":"2025090313002177000_6.1.e001091.3","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.080560"},{"key":"2025090313002177000_6.1.e001091.4","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.064717"},{"key":"2025090313002177000_6.1.e001091.5","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-206034"},{"key":"2025090313002177000_6.1.e001091.6","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1093\/rheumatology\/kex265","article-title":"Predictors and long-term outcome in Greek adults with juvenile idiopathic arthritis: a 17-year continuous follow-up study","volume":"56","author":"Dimopoulou","year":"2017","journal-title":"Rheumatology"},{"key":"2025090313002177000_6.1.e001091.7","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1002\/acr.22259","article-title":"Childhood arthritis and rheumatology research alliance consensus treatment plans for new-onset polyarticular juvenile idiopathic arthritis","volume":"66","author":"Ringold","year":"2014","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090313002177000_6.1.e001091.8","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-213030"},{"key":"2025090313002177000_6.1.e001091.9","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210715"},{"key":"2025090313002177000_6.1.e001091.10","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207524"},{"key":"2025090313002177000_6.1.e001091.11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/art.39480","article-title":"2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis","volume":"68","author":"Singh","year":"2016","journal-title":"Arthritis Rheumatol"},{"key":"2025090313002177000_6.1.e001091.12","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.med.59.062606.122232"},{"key":"2025090313002177000_6.1.e001091.13","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.143347"},{"key":"2025090313002177000_6.1.e001091.14","first-page":"390","article-title":"International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001","volume":"31","author":"Petty","year":"2004","journal-title":"J Rheumatol"},{"key":"2025090313002177000_6.1.e001091.15","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12969-016-0085-5","article-title":"Clinical outcome measures in juvenile idiopathic arthritis","volume":"14","author":"Consolaro","year":"2016","journal-title":"Pediatr Rheumatol Online J"},{"key":"2025090313002177000_6.1.e001091.16","doi-asserted-by":"publisher","DOI":"10.1367\/1539-4409(2003)003<0329:TPAAPP>2.0.CO;2"},{"key":"2025090313002177000_6.1.e001091.17","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1080\/01621459.2015.1086353","article-title":"Bayesian nonparametric estimation for dynamic treatment regimes with sequential transition times","volume":"111","author":"Xu","year":"2016","journal-title":"J Am Stat Assoc"},{"key":"2025090313002177000_6.1.e001091.18","doi-asserted-by":"publisher","DOI":"10.1093\/biostatistics\/kxw029"},{"key":"2025090313002177000_6.1.e001091.19","unstructured":"Huang B , Chen C , Liu J . GPMatch: a Bayesian doubly robust approach to causal inference with Gaussian process covariance function as a matching tool, 2019."},{"key":"2025090313002177000_6.1.e001091.20","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1080\/01621459.2016.1174132","article-title":"Multiple imputation of missing categorical and continuous values via Bayesian mixture models with local dependence","volume":"111","author":"Murray","year":"2016","journal-title":"J Am Stat Assoc"},{"key":"2025090313002177000_6.1.e001091.21","doi-asserted-by":"publisher","DOI":"10.1002\/art.34343"},{"key":"2025090313002177000_6.1.e001091.22","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2014.14"},{"key":"2025090313002177000_6.1.e001091.23","doi-asserted-by":"publisher","DOI":"10.1002\/art.11156"},{"key":"2025090313002177000_6.1.e001091.24","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1002\/art.40395","article-title":"The Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plans: toward comparative effectiveness in the pediatric rheumatic diseases","volume":"70","author":"Ringold","year":"2018","journal-title":"Arthritis Rheumatol"},{"key":"2025090313002177000_6.1.e001091.25","doi-asserted-by":"crossref","unstructured":"Huang B , Qiu T , Chen C , et al . Comparative effectiveness research using electronic health records data: ensure data quality. SAGE Res Methods Cases Med Heal 2020. To Appear.","DOI":"10.4135\/9781529726480"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2019-001091","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T20:00:29Z","timestamp":1756929629000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2019-001091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,2,2]]},"published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1136\/rmdopen-2019-001091"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2019-001091","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1]]}}}