{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T22:48:54Z","timestamp":1789858134845,"version":"4.0.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T00:00:00Z","timestamp":1627516800000},"content-version":"vor","delay-in-days":1243,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2009\/51897-5"],"award-info":[{"award-number":["2009\/51897-5"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2014\/14806-0"],"award-info":[{"award-number":["2014\/14806-0"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["303422\/2015-7"],"award-info":[{"award-number":["303422\/2015-7"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["305068\/2014-8"],"award-info":[{"award-number":["305068\/2014-8"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"crossref","award":["2009\/51897-5"],"award-info":[{"award-number":["2009\/51897-5"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"crossref","award":["2014\/14806-0"],"award-info":[{"award-number":["2014\/14806-0"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"crossref","award":["303422\/2015-7"],"award-info":[{"award-number":["303422\/2015-7"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"crossref","award":["305068\/2014-8"],"award-info":[{"award-number":["305068\/2014-8"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.tandfonline.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,3,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Objectives: To assess the rate of serious and\/or opportunistic infections in juvenile idiopathic arthritis (JIA) patients from a single tertiary center under biologic therapy and to identify possible risk factors associated to these complications.<\/jats:p>\n                  <jats:p>Methods: A total of 107 JIA patients followed at the biologic therapy center of our tertiary university hospital using a standardized electronic database protocol including demographic data, clinical and laboratorial findings and treatment at baseline and at the moment of infection. Opportunistic infections included tuberculosis, herpes zoster and systemic mycosis.<\/jats:p>\n                  <jats:p>Results: A total of 398 patient-yrs(py) were included. The median time of biologic exposure was 3.0 years (0.15\u201311.5). We observed 35 serious\/opportunistic infectious events in 27 (25%) patients: 31(88.6%) were serious infections and four (11.4%) opportunistic infections. Serious\/opportunistic infections rates were 10.6\/100py for ETN, 10.9\/100py for ADA, 2.6\/100py for ABA and 14.8\/100py for TCZ. Comparison of 27 patients with and 80 without infection showed a higher frequency of systemic-onset JIA, lower age at biologic therapy initiation and a history of previous serious infection (p\u2009&amp;lt;\u2009.05) in the former group.<\/jats:p>\n                  <jats:p>Conclusions: This study demonstrated a high rate of serious infections in JIA patients under biologic therapy in a real-life setting. Systemic-onset JIA, lower age at biologic therapy start and history of previous serious infections were important risk factors for these complications. Also, higher rates of severe infections comparing to the former studies was possibly due to elevated MTX doses in our patients.<\/jats:p>","DOI":"10.1080\/14397595.2017.1349059","type":"journal-article","created":{"date-parts":[[2017,9,26]],"date-time":"2017-09-26T11:34:39Z","timestamp":1506425679000},"page":"264-270","update-policy":"https:\/\/doi.org\/10.1080\/tandf_crossmark_01","source":"Crossref","is-referenced-by-count":11,"title":["High rate of serious infection in juvenile idiopathic arthritis patients under biologic therapy in a real-life setting"],"prefix":"10.1093","volume":"28","author":[{"given":"Juliana Barbosa","family":"Brunelli","sequence":"first","affiliation":[{"name":"Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , S\u00e3o Paulo, ;","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Renata","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , S\u00e3o Paulo, ;","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana Maluf Elias","family":"Sallum","sequence":"additional","affiliation":[{"name":"Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , S\u00e3o Paulo, ;","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Goldenstein-Schainberg","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , S\u00e3o Paulo,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eloisa","family":"Bonf\u00e1","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , S\u00e3o Paulo,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clovis A","family":"Silva","sequence":"additional","affiliation":[{"name":"Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , S\u00e3o Paulo, ;","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N\u00e1dia Emi","family":"Aikawa","sequence":"additional","affiliation":[{"name":"Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , S\u00e3o Paulo, ;","place":["Brazil"]},{"name":"Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , S\u00e3o Paulo,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,3,4]]},"reference":[{"key":"2026041420235674700_CIT0001","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s11926-013-0327-1","article-title":"Infectious complications in juvenile idiopathic arthritis","volume":"15","author":"Hurd","year":"2013","journal-title":"Curr Rheumatol Rep"},{"key":"2026041420235674700_CIT0002","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1136\/annrheumdis-2014-205351","article-title":"Efficacy and safety of tocilizumab in patients with polyarticular-course juvenile idiopathic arthritis: results from a phase 3, randomised, double-blind withdrawal trial","volume":"74","author":"Brunner","year":"2015","journal-title":"Ann Rheum Dis"},{"key":"2026041420235674700_CIT0003","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1093\/cid\/cit489","article-title":"Infections in children and adolescents with juvenile idiopathic arthritis and inflammatory bowel disease treated with tumor necrosis fator-\u03b1 inhibitors: systematic review of the literature","volume":"57","author":"Toussi","year":"2013","journal-title":"Clin Infect Dis"},{"key":"2026041420235674700_CIT0004","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11926-016-0593-9","article-title":"Biologics in pediatric rheumatology: quo vadis?","volume":"18","author":"Sterba","year":"2016","journal-title":"Curr Rheumatol Rep"},{"key":"2026041420235674700_CIT0005","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s11926-015-0542-z","article-title":"Biologic-associated infections in pediatric rheumatology","volume":"17","author":"Horneff","year":"2015","journal-title":"Curr Rheumatol Rep"},{"key":"2026041420235674700_CIT0006","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1186\/s13075-016-1170-3","article-title":"Comparison of treatment response, remission rate and drug adherence in polyarticular juvenile idiopathic arthritis patients treated with etanercept, adalimumab or tocilizumab","volume":"18","author":"Horneff","year":"2016","journal-title":"Arthritis Res Ther"},{"key":"2026041420235674700_CIT0007","doi-asserted-by":"crossref","first-page":"2773","DOI":"10.1002\/art.34458","article-title":"Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment","volume":"64","author":"Beukelman","year":"2012","journal-title":"Arthritis Rheum"},{"key":"2026041420235674700_CIT0008","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1002\/art.37866","article-title":"Incidence of selected opportunistic infections among children with juvenile idiopathic arthritis","volume":"65","author":"Beukelman","year":"2013","journal-title":"Arthritis Rheum"},{"key":"2026041420235674700_CIT0009","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1002\/acr.22961","article-title":"Risk of serious infection in juvenile idiopathic arthritis patients associated with tumor necrosis factor inhibitors and disease activity in the German biologics in pediatric rheumatology registry","volume":"69","author":"Becker","year":"2017","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026041420235674700_CIT0010","doi-asserted-by":"crossref","first-page":"2487","DOI":"10.1002\/art.39197","article-title":"Medically significant infections are increased in patients with juvenile idiopathic arthritis treated with etanercept: results from the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study","volume":"67","author":"Davies","year":"2015","journal-title":"Arthritis Rheumatol"},{"key":"2026041420235674700_CIT0011","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1093\/rheumatology\/keu457","article-title":"Occurrence of adverse events in patients with JIA receiving biologic agents: long-term follow-up in a real-life setting","volume":"54","author":"Tarkiainen","year":"2015","journal-title":"Rheumatology (Oxford)"},{"key":"2026041420235674700_CIT0012","first-page":"390","article-title":"International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001","volume":"31","author":"Petty","year":"2004","journal-title":"J Rheumatol"},{"key":"2026041420235674700_CIT0013","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.1056\/NEJMoa1112802","article-title":"Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis","volume":"367","author":"De Benedetti","year":"2012","journal-title":"N Engl J Med"},{"key":"2026041420235674700_CIT0014","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1002\/acr.20460","article-title":"2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features","volume":"63","author":"Beukelman","year":"2011","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026041420235674700_CIT0015","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.1002\/art.38092","article-title":"2013 update to the 2011 American College of Rheumatology recomendations for the treatment of juvenile idiopathic arthritis: recommendations for the medical therapy of children with systemic juvenile idiopathic arthritis and tuberculosis screening among children receiving biologic medications","volume":"65","author":"Ringold","year":"2013","journal-title":"Arthritis Care Res"},{"key":"2026041420235674700_CIT0016","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbr.2016.09.005","article-title":"Latent tuberculosis infection screening in juvenile idiopathic arthritis patients preceding anti-TNF therapy in a tuberculosis high-risk country","author":"Brunelli","year":"2016","journal-title":"Rev Bras Reumatol"},{"key":"2026041420235674700_CIT0017","first-page":"25","article-title":"Paediatric Rheumatology International Trials Organisation. The Brazilian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ)","volume":"19","author":"Machado","year":"2001","journal-title":"Clin Exp Rheumatol"},{"key":"2026041420235674700_CIT0018","first-page":"813","article-title":"Crosscultural reliability of the physical ability dimension of the health assessment questionnaire","volume":"17","author":"Ferraz","year":"1990","journal-title":"J Rheumatol"},{"key":"2026041420235674700_CIT0019","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1002\/art.24516","article-title":"Development and validation of a composite disease activity score for juvenile idiopathic arthritis","volume":"61","author":"Consolaro","year":"2009","journal-title":"Arthritis Rheum"},{"key":"2026041420235674700_CIT0020","first-page":"65","article-title":"The development of the disease activity score (DAS) and the disease activity score using 28 joint counts (DAS28)","volume":"32","author":"van Riel","year":"2014","journal-title":"Clin Exp Rheumatol"},{"key":"2026041420235674700_CIT0021","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13075-016-1109-8","article-title":"The risk of hospitalized infection following initiation of biologic agents versus methotrexate in the treatment of juvenile idiopathic arthritis","volume":"18","author":"Beukelman","year":"2016","journal-title":"Arthritis Res Ther"},{"key":"2026041420235674700_CIT0022","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s10067-014-2779-8","article-title":"A prospective study comparing infection risk and disease activity in children with juvenile idiopathic arthritis treated with and without tumor necrosis factor-alpha inhibitors","volume":"34","author":"Walters","year":"2015","journal-title":"Clin Rheumatol"},{"key":"2026041420235674700_CIT0023","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1007\/s00296-014-3197-6","article-title":"Incidence of herpes zoster infections in juvenile idiopathic arthritis patients","volume":"35","author":"Nimmrish","year":"2015","journal-title":"Rheumatol Int"},{"key":"2026041420235674700_CIT0024","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1002\/art.21885","article-title":"Long-term safety and efficacy of etanercept in children with polyarticular-course juvenile rheumatoid arthritis","volume":"54","author":"Lovell","year":"2006","journal-title":"Arthritis Rheum"},{"key":"2026041420235674700_CIT0025","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1002\/art.23427","article-title":"Safety and efficacy of up to eight years of continuous etanercept therapy in patients with juvenile rheumatoid arthritis","volume":"58","author":"Lovell","year":"2008","journal-title":"Arthritis Rheum"},{"key":"2026041420235674700_CIT0026","doi-asserted-by":"crossref","first-page":"8687","DOI":"10.1128\/JVI.01149-15","article-title":"The ORF61 protein encoded by simian varicella virus and varicella-zoster virus inhibits NF-\u03baB signaling by interfering with I\u03baB\u03b1 degradation","volume":"89","author":"Whitmer","year":"2015","journal-title":"J Virol"},{"key":"2026041420235674700_CIT0027","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1136\/annrheumdis-2015-207818","article-title":"Tocilizumab in systemic juvenile idiopathic arthritis in a real-world clinical setting: results from 1 year of postmarketing surveillance follow-up of 417 patients in Japan","volume":"75","author":"Yokota","year":"2016","journal-title":"Ann Rheum Dis"},{"issue":"1","key":"2026041420235674700_CIT0028","doi-asserted-by":"crossref","first-page":"34","DOI":"10.3109\/03009742.2012.709272","article-title":"Effective seroconversion and safety following the pandemic influenza vaccination (anti-H1N1) in patients with juvenile idiopathic arthritis","volume":"42","author":"Aikawa","year":"2013","journal-title":"Scand J Rheumatol"},{"issue":"5","key":"2026041420235674700_CIT0029","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.vaccine.2014.12.030","article-title":"Short and long-term immunogenicity and safety following the 23-valent polysaccharide pneumococcal vaccine in juvenile idiopathic arthritis patients under conventional DMARDs with or without anti-TNF therapy","volume":"33","author":"Aikawa","year":"2015","journal-title":"Vaccine"},{"key":"2026041420235674700_CIT0030","first-page":"56","article-title":"Tuberculosis risk in patients treated with non-anti-tumor necrosis factor-\u03b1 (TNF-\u03b1) targeted biologics and recently licensed TNF-\u03b1 inhibitors: data from clinical trials and national registries","volume":"91","author":"Cantini","year":"2014","journal-title":"J Rheumatol"},{"key":"2026041420235674700_CIT0031","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/1546-0096-12-45","article-title":"Immunity against Mycobacterium tuberculosis and the risk of biologic anti anti-TNF-\u03b1 reagents","volume":"12","author":"Yasui","year":"2014","journal-title":"Pediatr Rheumatol"},{"key":"2026041420235674700_CIT0032","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.rbr.2015.03.010","article-title":"Systemic and localized infection by Candida species in patients with rheumatic diseases receiving anti-TNF therapy","volume":"56","author":"Aikawa","year":"2016","journal-title":"Rev Bras Reumatol Engl Ed"},{"key":"2026041420235674700_CIT0033","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/S0025-6196(11)60839-2","article-title":"Fungal infections complicating tumor necrosis factor alpha blockade therapy","volume":"83","author":"Tsiodras","year":"2008","journal-title":"Mayo Clin Proc"}],"container-title":["Modern Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mr\/article-pdf\/28\/2\/264\/39321284\/mr0264.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mr\/article-pdf\/28\/2\/264\/39321284\/mr0264.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:47:07Z","timestamp":1776214027000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mr\/article\/28\/2\/264\/6300252"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,4]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,3,4]]},"published-print":{"date-parts":[[2018,3,4]]}},"URL":"https:\/\/doi.org\/10.1080\/14397595.2017.1349059","relation":{},"ISSN":["1439-7609","1439-7595"],"issn-type":[{"value":"1439-7609","type":"electronic"},{"value":"1439-7595","type":"print"}],"subject":[],"published-other":{"date-parts":[[2018,3,4]]},"published":{"date-parts":[[2018,3,4]]},"assertion":[{"value":"The publishing and review policy for this title is described in its Aims & Scope.","order":1,"name":"peerreview_statement","label":"Peer Review Statement"},{"value":"http:\/\/www.tandfonline.com\/action\/journalInformation?show=aimsScope&journalCode=imor20","URL":"http:\/\/www.tandfonline.com\/action\/journalInformation?show=aimsScope&journalCode=imor20","order":2,"name":"aims_and_scope_url","label":"Aim & Scope"},{"value":"2017-02-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-06-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-09-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}