Treat-to-Target Strategies and Early Biologic Initiation in Polyarticular Juvenile Idiopathic Arthritis: Translating Evidence into Clinical Practice

Juvenile idiopathic arthritis (JIA) is among the most prevalent chronic inflammatory rheumatic diseases in children. Over the past two decades, the treatment landscape has evolved significantly with the introduction of biologic disease-modifying antirheumatic drugs and the adoption of treat-to-target strategies aimed at achieving clinically inactive disease. Early initiation of biologic therapies can facilitate rapid disease control and improve long-term outcomes. However, the implementation and integration of newer treatments within the current healthcare system are often hindered by insurance authorization requirements, high costs, and variability in clinical practice. This review evaluates current evidence-based approaches supporting the treat-to-target strategy and early biologic intervention in polyarticular JIA. Additionally, it discusses the practical challenges of translating evidence into routine clinical care and proposes sustainable strategies to optimize treatment outcomes while addressing existing knowledge and practice gaps.