Timothy Beukelman, MD, associate professor in the Division of Pediatric Rheumatology at the University of Alabama at Birmingham, is not entirely surprised by the study findings. “Many pediatric rheumatologists, myself included, believe in the concept of a window of opportunity in the treatment of JIA. This means that early, aggressive therapy to rapidly bring the disease under control may, in fact, have benefits may years into the future.”

“This study confirms our clinical suspicion that early, aggressive therapy results in better outcomes,” says Dr. Beukelman, who was not involved in the study. “One thing we learned from this study is that even a one-month delay in initiating aggressive therapy had significant impact on short-term outcomes.”

Harry L. Gewanter, MD, a pediatric rheumatologist in private practice in Richmond, Va. and a Mid-Atlantic Region board member of the Arthritis Foundation, says this study provides concrete guidance on the best way to treat these young patients. “We all thought this was the way to go, now we have some data,” says Dr. Gewanter, who was also not involved in this study. “The outcomes weren’t good with starting low and slow and moving your way up.”

This information is particularly valuable to physicians who aren’t pediatric rheumatologists who may encounter children with juvenile arthritis, because of the lack of specialists in this area. For example, there are only a half dozen pediatric rheumatologists in the state of Virginia, Dr. Gewanter says, so some young patients may be treated by adult rheumatologists. For general practitioners who may not immediately recognize the signs of juvenile arthritis, Dr. Gewanter says the main message is: “If a child comes in with a swollen joint that won’t go away, don’t blow it off.”