Pediatric Rheumatology - A comparison of three treatment strategies in recent onset non-systemic Juvenile Idiopathic Arthritis - initial 3-months results of the BeSt for Kids-study

Sep 10, 2026

Background: Combination therapy with prednisone or etanercept may improve disease activity earlier in Disease Modifying Anti Rheumatic Drug (DMARD) naïve non-systemic Juvenile Idiopathic Arthritis (JIA). The BeSt for Kids study reports three-month clinical outcomes of initial treatment strategies. Methods: randomized arms compared initial DMARD monotherapy (sulfasalazine or methotrexate), MTX/prednisolone bridging, or MTX/etanercept combination; inactive disease and side effects were assessed using intention-to-treat analyses. Results: combination therapy achieved higher aACR Pedi70 responses at three months with toxicity comparable across arms. Conclusion: MTX/etanercept led to significantly more early clinical improvement than MTX or sulfasalazine monotherapy.

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Hissink Muller et al. Pediatric Rheumatology (2017) 15:11 DOI 10.1186/s12969-017-0138-4 SHORT REPORT Open Access A comparison of three treatment strategies in recent onset non-systemic Juvenile Idiopathic Arthritis: initial 3-months results of the BeSt for Kids-study P. C. E. Hissink Muller 1,6*, D. M. C. Brinkman 1,2, D. Schonenberg3, Y. Koopman-Keemink4, I. C. J. Brederije 1, W. P. Bekkering 1, T. W. Kuijpers3, M. A. J. van Rossum5, L. W. A. van Suijlekom-Smit6, J. M. van den Berg3, C. F. Allaart7 and R. ten Cate 1 Abstract Background: Combination therapy with prednisone or etanercept may induce earlier and/or more improvement in disease activity in Disease Modifying Anti Rheumatic Drug (DMARD) naïve non-systemic Juvenile Idiopathic Arthritis (JIA) patients. Here we present three months clinical outcome of initial treatments of the BeSt-for-Kids study. Methods: Included patients were randomized to either: 1 . initial DMARD-monotherapy (sulfasalazine (SSZ) or methotrexate (MTX)), 2 . Initial MTX / prednisolone-bridging, 3 . Initial combination MTX/etanercept. Percentage inactive disease, adjusted (a) ACR Pedi30, 50 and 70 and JADAS after 6 and 12 weeks of treatment (intention to treat analysis) and side effects are reported. Results: 94 patients (67% girls, 32 (arm 1), 32 (arm 2) and 30 (arm 3) with median (InterQuartileRange) age of 9. 1 (4.7-12.9) years were included. 38% were ANA positive, 10 had oligo-articular disease, 68 polyarticular JIA and 16 psoriatic arthritis. Baseline median (IQR) ACRpedi-scores: VAS physician 49 (40-58) mm, VAS patient 54 (37-70) mm, ESR 6.5 (2-14.8)mm/hr, active joint count 8 (5-12), limited joint count 3 (1-5), CHAQ score 0 . 88 (0 .63-1. 5) . In arm 1, 17 started with MTX, 15 with SSZ. After 3 months, aACR Pedi 50 was reached by 10/32 (31%), 12/32(38%) and 16/30 (53%) (p = 0.19) and aACRPedi 70 was reached by 8/32 (25%), 6/32(19%) and 14/30(47%) in arms 1-3 (p = 0 . 04) . Toxicity was similar. Few serious adverse events were reported. Conclusion: After 3 months of treatment in a randomized trial, patients with recent-onset JIA achieved significantly more clinical improvement (aACRPedi70) on initial combination therapy with MTX / etanercept than on initial MTX or SSZ monotherapy. Trial registration: NTR1574 . Registered 3 December 2008 . Keywords: Juvenile idiopathic arthritis, Treat to target, Window of opportunity, Treatment strategy study, Biologicals, Inactive disease * Correspondence: [p.hissinkmuller@lumc.nl](p.hissinkmuller@lumc.nl) 1Department of Pediatrics/Pediatric Rheumatology, Leiden University Medical Center, Leiden, The Netherlands 6Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands Full list of author information is available at the end of the article © The Author(s) . 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4 .0 International License ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ([http://creativecommons.org/publicdomain/zero/1.0/](http://creativecommons.org/publicdomain/zero/1.0/)) applies to the data made available in this article, unless otherwise stated. Introduction Juvenile Idiopathic Arthritis (JIA) is the most common auto-immune disease in children [1] except for systemic JIA which is nowadays viewed as an autoinflammatory disease [2] . Many children suffer from chronic functional disability and damage due to prolonged inflammation [3] . The ILAR criteria divide the heterogeneous disease in 7 categories [4] . Prognosis is difficult to predict and even oligoarticular disease can ha

FAQs

What treatment strategies were compared in the BeSt for Kids study?

Three arms compared initial DMARD monotherapy (sulfasalazine or methotrexate), initial MTX/prednisolone bridging, and initial combination MTX/etanercept.

How was clinical improvement evaluated after three months?

Inactive disease outcomes were assessed using adjusted ACR Pedi30, 50, and 70 and JADAS at specified treatment weeks, using intention-to-treat analyses.

Which initial therapy produced the best three-month results?

Initial MTX/etanercept combination therapy achieved significantly more early clinical improvement (aACR Pedi70) than initial MTX or sulfasalazine monotherapy.

Sep 10, 2026

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