Evaluate the Feasibility of Surgical Transversus Abdominis Plane Block for Postoperative Analgesia After Cesarean Section.

INTRODUCTION

Juvenile idiopathic arthritis (JIA) is a chronic autoimmune condition that can lead to significant complications if not promptly managed. Current guidelines recommend biologic or targeted synthetic disease modifying antirheumatic drugs (b/tsDMARDs) as part of the treatment algorithm. In the USA, patients are covered by a wide range of insurance plans that can be broadly classified into two categories-public or private. The influence of insurance type on access to JIA therapies and subsequent outcomes remains poorly understood. The objective of this study was to investigate how b/tsDMARD initiation and achievement of clinically inactive disease (CID) may differ by insurance type in patients with nonsystemic forms of JIA.

METHODS

Patients newly diagnosed with JIA according to International League of Associations (ILAR) for Rheumatology classification criteria between 2009 and 2020 at a large tertiary center were studied. Outcome variables of time to b/tsDMARD initiation and time to CID of JIA were assessed. Descriptive statistics were performed, and patients with public or private insurance were compared cross-sectionally and over the study timeframe using survival analysis.

RESULTS

There were 968 patients with newly diagnosed JIA during the study period; 753 (78%) were privately insured and 215 (22%) were publicly insured. During 5898 patient-years of follow-up, 562 (58%) patients initiated b/tsDMARDs and 677 (70%) patients achieved CID. Time to b/tsDMARD initiation did not differ by insurance type (both approximately 5 months, p = 0.51). Publicly insured patients had higher baseline disease activity and longer time to CID achievement compared with the privately insured (10 months versus 7 months, p < 0.001).

CONCLUSION

While time to b/tsDMARD initiation was similar across insurance groups, publicly insured patients achieved CID later than privately insured patients. These findings may be interpreted as insurance-associated differences. Additional studies are needed to clarify the roles of baseline disease severity, healthcare access, adherence, and socioeconomic context factors.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40267-026-01241-0.