Variation in the access and use of biologic and targeted synthetic DMARDs in juvenile idiopathic arthritis: insights from a national United Kingdom (UK) survey
Authors' conclusion
Selection and access to effective b/tsDMARD therapies for JIA varies considerably across the UK, shaped by commissioning structures, age thresholds and specialty pathways rather than clinical need.
Study context
- Population
- Paediatric and adolescent rheumatology multidisciplinary teams (MDTs) at tertiary and quaternary centres across the four UK nations13 of 17 (76%) centres
- Participants
- 123 participants
- Outcome
- b/tsDMARD selection and access in JIA
Methodological detailsnational survey, 26-question survey, qualitative thematic analysis, non-parametric permutation testing
- National survey
- 26-question survey
- Qualitative thematic analysis
- Non-parametric permutation testing
Main finding
As reported in the abstract
- Adalimumab most commonly used first-line for all juvenile idiopathic arthritis (JIA) subtypes except systemic JIA (sJIA)/Still's disease
- Tocilizumab frequently used second-line across multiple subtypes (incl. polyarticular disease, uveitis); widely used first- and second-line in sJIA/Still's
- Anakinra commonly used in sJIA, particularly in macrophage activation syndrome (MAS)
- England and Wales: canakinumab for sJIA unavailable despite supportive trial evidence; adalimumab the only commissioned therapy for JIA-associated uveitis
- Paediatric access to anti-IL-17 agents for enthesitis-related arthritis (ERA) limited
- Broader therapeutic choice and higher biologic dosing more accessible via dermatology or gastroenterology pathways (e.g. psoriatic JIA, inflammatory bowel disease (IBD)-associated arthritis)
- Adult/adolescent rheumatologists reported wider biologic access, though reclassification to adult diagnoses sometimes required
- Biosimilars universally adopted; specialist pharmacy support for implementation inconsistent
- External advice sought for refractory disease, incl. consideration of haematopoietic stem cell transplantation and combination biologic therapy
Observational data: associations, not effects.
Original publication
Variation in the access and use of biologic and targeted synthetic DMARDs in juvenile idiopathic arthritis: insights from a national UK survey. Pediatr Rheumatol Online J. Published 6 July 2026. doi:10.
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