OBJECTIVES: Rituximab (RTX) may be a treatment option for children and young 
people with JIA, although it is not licensed for this indication. The aim of 
this study was to describe RTX use and outcomes among children with JIA.
METHODS: This analysis included all JIA patients within the UK Biologics for 
Children with Rheumatic Diseases study starting RTX. Disease activity was 
assessed at RTX start and at follow-up. The total number of courses each patient 
received was assessed. Serious infections and infusion reactions occurring 
following RTX were reported.
RESULTS: Forty-one JIA patients starting RTX were included, the majority with 
polyarthritis: polyarthritis RF negative [n = 14 (35%)], polyarthritis RF 
positive [n = 13 (33%)] and extended oligoarthritis [n = 9 (23%)]. Most were 
female (80%) with a median age of 15 years [interquartile range (IQR) 12-16] and 
a median disease duration of 9 years (IQR 5-11). The median improvement in the 
clinical Juvenile Arthritis Disease Activity Score (cJADAS; three-variable 
71-joint JADAS) from RTX start was 9 units (n = 7; IQR -14-2). More than half 
reported more than one course of RTX. The median time between each course was 
219 days (IQR 198-315). During follow-up, 17 (41%) patients reported switching 
to another biologic, including tocilizumab (n = 8), abatacept (n = 6) and TNF 
inhibitor (n = 3). Three patients (7%) reported a serious infection on RTX (rate 
of first serious infection 6.2/100 person-years). Four patients (10%) reported 
an infusion reaction.
CONCLUSIONS: This real-world cohort of children with JIA, the majority with 
polyarticular or extended oligoarticular JIA, showed RTX may be an effective 
treatment option for children who do not respond to TNF inhibitor, with a low 
rate of serious infections on treatment.