{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T13:36:30Z","timestamp":1791466590562,"version":"4.3.4"},"reference-count":46,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,7,25]],"date-time":"2018-07-25T00:00:00Z","timestamp":1532476800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["2P60\u2010AR\u2010047784\u201006A2"],"award-info":[{"award-number":["2P60\u2010AR\u2010047784\u201006A2"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      To determine the frequency, time to flare, and predictors of disease flare upon withdrawal of anti\u2013tumor necrosis factor (anti\u2010\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      ) therapy in children with polyarticular forms of juvenile idiopathic arthritis (\n                      <jats:styled-content style=\"fixed-case\">JIA<\/jats:styled-content>\n                      ) who demonstrated \u22656 months of continuous clinically inactive disease.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In 16 centers 137 patients with clinically inactive\n                      <jats:styled-content style=\"fixed-case\">JIA<\/jats:styled-content>\n                      who were receiving anti\u2010\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      therapy (42% of whom were also receiving methotrexate [\n                      <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content>\n                      ]) were prospectively followed up. If the disease remained clinically inactive for the initial 6 months of the study, anti\u2010\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      was stopped and patients were assessed for flare at 1, 2, 3, 4, 6, and 8 months. Life\u2010table analysis,\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests, chi\u2010square test, and Cox regression analysis were used to identify independent variables that could significantly predict flare by 8 months or time to flare.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 137 patients, 106 (77%) maintained clinically inactive disease while receiving anti\u2010\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      therapy for the initial 6 months and were included in the phase of the study in which anti\u2010\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      therapy was stopped. Stopping anti\u2010\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      resulted in disease flare in 39 (37%) of 106 patients by 8 months. The mean\/median \u00b1\n                      <jats:styled-content style=\"fixed-case\">SEM<\/jats:styled-content>\n                      time to flare was 212\/250 \u00b1 9.77 days. Patients with shorter disease duration at enrollment, older age at onset and diagnosis, shorter disease duration prior to experiencing clinically inactive disease, and shorter time from onset of clinically inactive disease to enrollment were found to have significantly lower hazard ratios for likelihood of flare by 8 months (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Over one\u2010third of patients with polyarticular\n                      <jats:styled-content style=\"fixed-case\">JIA<\/jats:styled-content>\n                      with sustained clinically inactive disease will experience a flare by 8 months after discontinuation of anti\u2010\n                      <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\n                      therapy. Several predictors of lower likelihood of flare were identified.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/art.40509","type":"journal-article","created":{"date-parts":[[2018,3,31]],"date-time":"2018-03-31T08:31:39Z","timestamp":1522485099000},"page":"1508-1518","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Risk, Timing, and Predictors of Disease Flare After Discontinuation of Anti\u2013Tumor Necrosis Factor Therapy in\u00a0Children With Polyarticular Forms of Juvenile Idiopathic\u00a0Arthritis With Clinically Inactive Disease"],"prefix":"10.1002","volume":"70","author":[{"given":"Daniel J.","family":"Lovell","sequence":"first","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center Cincinnati Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne L.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center Cincinnati Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Huang","sequence":"additional","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center Cincinnati Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth S.","family":"Gottlieb","sequence":"additional","affiliation":[{"name":"The Steven and Alexandra Cohen Children's Medical Center of New York New Hyde Park New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula W.","family":"Morris","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Science Little Rock"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiko","family":"Kimura","sequence":"additional","affiliation":[{"name":"Hackensack University Medical Center Joseph M. 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