Advancing Research and Care in Juvenile Arthritis, With Yukiko Kimura, MD

Management for juvenile idiopathic arthritis (JIA), the most common rheumatologic disease in children, has undergone a dramatic shift in outcomes over the past 2 decades. Once a condition that frequently left children with visible disability, limited mobility, and lifelong complications, JIA is now often managed successfully with targeted therapies that prevent severe damage and help children live active, healthy lives. This progress is largely attributed to the advent of biologics, beginning with TNF inhibitors and now extending to a wide array of therapies with distinct mechanisms of action, including IL-6 inhibitors, T-cell co-stimulation blockers, and JAK inhibitors.1 The expansion of treatment options has not only improved quality of life but has also transformed how clinicians approach disease control in pediatric populations.

Alongside therapeutic breakthroughs, international collaboration has become a driving force in JIA research. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) in North America and the Pediatric Rheumatology European Society (PReS) have joined efforts to launch some of the first global investigator-initiated studies in this space. One such initiative, the SMART-JIA trial, seeks to address a longstanding clinical question: how to optimize treatment strategies for patients who do not respond to first-line biologics.2 With multiple biologic and targeted options available, determining which pathway to pursue after treatment failure remains a challenge for clinicians. Another critical area of investigation focuses on when and how it may be safe to taper or discontinue therapy, an issue of great importance for patients and families navigating long-term treatment.

HCPLive spoke with Yukiko Kimura, MD, Chief of Pediatric Rheumatology at Hackensack University Medical Center, and Professor of Pediatrics at the Hackensack Meridian School of Medicine, to learn more about her experience with the evolving treatment landscape. Kimura, who is also cochair of the CARRA Registry and Research Oversight Committee (RROC), also highlighted the importance of ongoing research to address these pressing questions in JIA care.

“The kids that get diagnosed [with pediatric arthritis] can really benefit from knowledge of specialists in this area who know how to use [biologics] and can treat them the way that they should be,” Kimura said.

References

1. Shishov M, Weiss PF, Levy DM, et al. 25 Years of Biologics for the Treatment of Pediatric Rheumatic Disease: Advances in Prognosis and Ongoing Challenges. Arthritis Care Res (Hoboken). 2025;77(5):573-583. doi:10.1002/acr.25482

2. Trial of Sequential Medications After TNF Failure (SMART) and Precision Treatment Decisions in Juvenile Idiopathic Arthritis. CARRA. https://carragroup.org/grant/trial-of-sequential-medications-after-tnf-failure-smart-and-precision-treatment-decisions-in-juvenile-idiopathic-arthritis/