Impact of Health Care Financing Models on Biological Agent Accessibility and Clinical Outcomes in Juvenile Idiopathic Arthritis: A Comparative Study From Türkiye and India

Objective: Biological treatments have transformed juvenile idiopathic arthritis (JIA) outcomes, yet their availability and cost remain challenging. We investigated the impact of 2 different health care systems on the JIA disease course and outcomes. Materials and Methods: JIA patients presenting to 2 tertiary centers in Türkiye and India between January 2014 and January 2025, with ≥1 year of follow-up, were enrolled. Systemic JIA (sJIA) patients were analyzed separately due to differing management and prognosis. Data at 6 months, 1, 2, 3, and 5 years if follow-up occurred, were obtained retrospectively. Results: A total of 207 patients were enrolled: 15 sJIA and 129 non-sJIA from Türkiye, and 12 sJIA and 51 non-sJIA from India. Biological disease-modifying antirheumatic drugs (bDMARDs) were prescribed significantly more often in the Turkish cohort (46% vs. 23%, p =0.001). In contrast, systemic corticosteroid use was significantly higher in the Indian cohort (26% vs. 69%, p =0.001). Initial remission was achieved more rapidly in the Turkish cohort (median month 2 vs. 4, p <0.001), and the number of patients with active joints and elevated acute-phase reactants was consistently higher in the Indian cohort throughout all follow-up periods. Conclusions: Universal health care coverage was associated with early initiation and sustained use of bDMARDs, leading to more rapid control of disease activity. In contrast, when bDMARDs were unavailable, physicians were forced to rely more heavily on systemic corticosteroids. Interestingly, JIA-related complications such as chronic joint involvement and uveitis did not significantly differ between the Turkish and Indian cohorts, possibly due to differences in ethnic and disease characteristics, survivor bias, and the limited number of patients with such complications.