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The purpose of this study was to identify patient\u2010specific patterns of joint flare to distinguish local from systemic drivers of disease chronicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with juvenile idiopathic arthritis followed without interruption from disease onset into adulthood were identified across 2 large academic centers. Joints inflamed at each visit were established by medical record review. Flare was defined as physician\u2010confirmed joint inflammation following documented inactive disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 222 adults with JIA, 95 had complete serial joint examinations dating from disease onset in childhood. Mean follow\u2010up was 12.5\u2009years (interquartile range 7.9\u201316.7\u2009years). Ninety (95%) of 95 patients achieved inactive disease, after which 81% (73 patients) experienced at least 1 flare. Among 940 joints affected in 253 flares, 74% had been involved previously. In flares affecting easily observed large joint pairs where only 1 side had been involved before (n\u00a0=\u00a053), the original joint was affected in 83% and the contralateral joint in 17% (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001 versus random laterality). However, disease extended to at least 1 new joint in ~40% of flares, a risk that remained stable even decades after disease onset, and was greatest in flares that occurred while patients were not receiving medication (54% versus 36% of flares occurring with therapy; odds ratio 2.09,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.015).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Arthritis flares preferentially affect previously inflamed joints but carry an ongoing risk of disease extension. These findings confirm joint\u2010specific memory and suggest that prevention of new joint accumulation should be an important target for arthritis therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/art.42240","type":"journal-article","created":{"date-parts":[[2022,5,24]],"date-time":"2022-05-24T00:22:57Z","timestamp":1653351777000},"page":"1851-1858","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Joint\u2010Specific Memory and Sustained Risk for New Joint Accumulation in Autoimmune Arthritis"],"prefix":"10.1002","volume":"74","author":[{"given":"Margaret H.","family":"Chang","sequence":"first","affiliation":[{"name":"Division of Immunology Boston Children's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra V.","family":"Bocharnikov","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siobhan M.","family":"Case","sequence":"additional","affiliation":[{"name":"Division of Immunology Boston Children's Hospital and Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Todd","sequence":"additional","affiliation":[{"name":"Division of Immunology Boston Children's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Laird\u2010Gion","sequence":"additional","affiliation":[{"name":"Division of Immunology Boston Children's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maura","family":"Alvarez\u2010Baumgartner","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2126-3702","authenticated-orcid":false,"given":"Peter A.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Division of Immunology Boston Children's Hospital and Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,30]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.125278"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780310215"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-220882"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.40350"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-021-00590-6"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.21857"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205372"},{"key":"e_1_2_6_9_1","first-page":"390","article-title":"International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001","volume":"31","author":"Petty RE","year":"2004","journal-title":"J Rheumatol"},{"key":"e_1_2_6_10_1","unstructured":"United States Food and Drug Administration.Drugs@FDA: FDA\u2010Approved Drugs. 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