Juvenile arthritis damage index predicts poor response to biological treatment: A prospective cohort study

doi:10.5409/wjcp.v14.i4.108878

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World Journal of Clinical Pediatrics

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2219-2808

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

World J Clin Pediatr. Dec 9, 2025; 14(4): 108878
Published online Dec 9, 2025. doi: 10.5409/wjcp.v14.i4.108878

Juvenile arthritis damage index predicts poor response to biological treatment: A prospective cohort study

Zarina A Kolkhidova, Irina P Nikishina, Svetlana I Glukhova, Oleg G Melikhov, Mikhail M Kostik

Zarina A Kolkhidova, Irina P Nikishina, Svetlana I Glukhova, Department of Pediatric Rheumatology, V.A. Nasonova Research Institute of Rheumatology, Moscow 115522, Moskva, Russia

Oleg G Melikhov, Department of Clinical, Institute of Clinical Research, Moscow 119590, Moskva, Russia

Mikhail M Kostik, Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Sankt-Peterburg, Russia

Co-first authors: Zarina A Kolkhidova and Irina P Nikishina.

Author contributions: Kolkhidova ZA, Nikishina IP, and Kostik MM conceptualized the manuscript, provided resources, and wrote the manuscript; Kolkhidova ZA and Nikishina IP contributed equally to this article, they are the co-first authors of this manuscript; Nikishina IP, Kostik MM, Kolkhidova ZA, and Melikhov OG designed the manuscript; Nikishina IP contributed supervision; Nikishina IP and Kolkhidova ZA provided materials for the manuscript and conducted a literature search; Kolkhidova ZA performed data collection and/or processing; Nikishina IP, Kolkhidova ZA, and Glukhova SI performed analysis and/or data interpretation; Nikishina IP, Glukhova SI, Melikhov OG, and Kostik MM conducted critical review; and all authors were involved in drafting or revising the article for important intellectual content, and all authors approved the final version to be published.

Supported by an Independent Grant from Pfizer.

Institutional review board statement: This study was approved by the Medical Ethics Committee of V.A. Nasonova Institute of Rheumatology, approval No. 22.

Clinical trial registration statement: This study is registered at URL: https://rheumatolog.su/specialists/ds/dissertations/de8b017c-33b0-4145-b208-fda219cf5be2/. The registration identification No. 22, dated November 23, 2021.

Informed consent statement: According to the Declaration of Helsinki, written consent from the parents and patients older than 14 years has been obtained.

Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Mikhail M Kostik, MD, PhD, Professor, Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint Petersburg 194100, Sankt-Peterburg, Russia. kost-mikhail@yandex.ru

Received: April 24, 2025
Revised: May 11, 2025
Accepted: August 12, 2025
Published online: December 9, 2025
Processing time: 190 Days and 2.7 Hours

Abstract

BACKGROUND

Juvenile arthritis damage index (JADI) is a tool that measures the degree of aggressiveness of the juvenile idiopathic arthritis (JIA) course and assesses articular [JADI - articular damage (JADI-A)] and extraarticular [JADI - extraarticular damage (JADI-E)] damage. While aggressive JIA often requires early biologic disease-modified antirheumatic drugs (bDMARDs), the utility of JADI as a predictor of treatment response remains underexplored.

AIM

To evaluate the potential of JADI as a predictor of bDMARD treatment response in JIA patients.

METHODS

This prospective study included 112 highly active non-systemic JIA biologic-naïve patients with a mean age of 12.2 ± 4.6 years and a median disease duration of 2.5 (interquartile range: 1-5) years. Their clinical and radiological assessment, juvenile arthritis disease activity score 71, JADI-A, and JADI-E, were evaluated twice: Before the biologic initiation (baseline) and 12 months after (end of study). At baseline, 50% had any damage, with 43% with articular damage and 23% with extraarticular damage.

RESULTS

During the study, JADI-A/JADI-E improved (33.9%/9.8%), worsened (8.9%/5.4%), or remained unchanged (57.1%/84.8%). Patients with baseline damage had higher markers of JIA activity: Polyarticular course, earlier onset age, ANA-positivity, and more active joints. Patients without initial structural damage (JADI“-“) were more likely (odds ratio = 3.8, 95% confidence interval: 1.6-9.0, P < 0.004) to achieve a low degree of activity or remission (46.2%), while on biological therapy, their scores were comparable to JADI-positive (18.3%). Pre-biological joint damage according to the JADI-A index (P = 0.003), wrist (P = 0.035), elbow (P = 0.027), cervical spine limitation of motion (P = 0.051), and erosions confirmed by magnetic resonance imaging (P = 0.002), were associated with poor response to biological treatment and follow-up JIA activity.

CONCLUSION

Baseline structural damage in JIA is associated with diminished bDMARDs efficacy, increased disability, and shorter remission duration. JADI enhances conventional clinical risk stratification by facilitating timely initiation of bDMARDs, adherence to treat-to-target strategy and tailored patient care.

Keywords: Juvenile idiopathic arthritis; Juvenile arthritis damage index; Biologic disease-modified antirheumatic drugs; Joint contractures; Treatment response prediction; Pediatric rheumatology

Core Tip: This prospective study of biological-naïve juvenile idiopathic arthritis patients demonstrates that baseline articular/extraarticular damage (assessed via the juvenile arthritis damage index) predicts reduced response to biological disease-modifying antirheumatic drugs. Patients with baseline damage demonstrated higher disease activity (polyarticular course, elevated juvenile arthritis disease activity score 71, magnetic resonance imaging erosions) than those without damage. The observed juvenile arthritis damage index reduction in juvenile idiopathic arthritis patients showed significant associations with baseline joint damage status, treatment stability, and absence of uveitis/osteonecrosis. This index encourages early biologic intervention and tailoring personalized treatment strategies to minimize long-term disability and enhance clinical outcomes.