{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T03:43:51Z","timestamp":1764906231982,"version":"3.28.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T00:00:00Z","timestamp":1709596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,15]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Although treatments for juvenile idiopathic arthritis (JIA) have seen considerable advancements, there remains a lack of clear guidelines on withdrawing medications. This study aimed to investigate the current strategies for discontinuing non-systemic JIA treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A web-based questionnaire was distributed to members of the Pediatric Rheumatology Association of Japan.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>According to 126 responses, the most significant factors influencing JIA treatment tapering were the duration of clinically inactive disease, medication toxicity, and a history of arthritis flares. Respondents were often cautious about discontinuing medication if symptoms, e.g. \u2018morning stiffness\u2019 or \u2018intermittent joint pain\u2019, persisted. Among subtypes, oligoarticular JIA was more amenable to treatment tapering, whereas rheumatoid factor\u2013positive polyarticular JIA proved less amenable. Most respondents started medication tapering after a continuous clinical inactive duration exceeding 12\u2009months, and &amp;gt;50% of them required &amp;gt;6\u2009months to achieve treatment discontinuation. Additionally, 40% of the respondents consistently underwent imaging before treatment tapering.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The relative risks of treatment continuation and withdrawal should be considered, and decisions should be made accordingly. To obtain improved understanding of and more robust evidence for the optimal strategies for safely discontinuing JIA treatment, it is crucial to continue investigations including long-term outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/mr\/roae016","type":"journal-article","created":{"date-parts":[[2024,3,2]],"date-time":"2024-03-02T06:35:04Z","timestamp":1709361304000},"page":"1231-1237","source":"Crossref","is-referenced-by-count":3,"title":["Evaluation of medication withdrawal in patients with non-systemic juvenile idiopathic arthritis in Japan using a web-based survey"],"prefix":"10.1093","volume":"34","author":[{"given":"Takasuke","family":"Ebato","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Kitasato University , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takayuki","family":"Kishi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Tokyo Women\u2019s Medical University , Tokyo,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiji","family":"Akamine","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Rheumatology, Tokyo Metropolitan Children\u2019s Medical Center , Tokyo,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomo","family":"Nozawa","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Graduate School of Medicine, Yokohama City University , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoyuki","family":"Imagawa","sequence":"additional","affiliation":[{"name":"Department of Infection and Immunology, Kanagawa Children\u2019s Medical Center , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Bando","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kitasato University Medical Center , Saitama,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takako","family":"Miyamae","sequence":"additional","affiliation":[{"name":"Department of Pediatric Rheumatology, Institute of Rheumatology, Tokyo Women\u2019s Medical University Hospital , Tokyo,","place":["Japan"]},{"name":"Division of Rheumatology, Department of Internal Medicine, Tokyo Women\u2019s Medical University School of Medicine , Tokyo,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,3,5]]},"reference":[{"key":"2024110410415302900_R1","first-page":"390","article-title":"International League of Associations criteria for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001","volume":"31","author":"Petty","year":"2004","journal-title":"J Rheumatol"},{"key":"2024110410415302900_R2","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1080\/14397595.2018.1514724","article-title":"Clinical practice guidance for juvenile idiopathic arthritis (JIA) 2018","volume":"29","author":"Okamoto","year":"2019","journal-title":"Mod Rheumatol"},{"key":"2024110410415302900_R3","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1002\/acr.23870","article-title":"2019 American College of Rheumatology\/Arthritis Foundation Guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for non-systemic polyarthritis, sacroiliitis, and enthesitis","volume":"71","author":"Ringold","year":"2019","journal-title":"Arthritis Care Res"},{"key":"2024110410415302900_R4","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1002\/art.42037","article-title":"2021 American College of Rheumatology Guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for oligoarthritis, temporomandibular joint arthritis, and systemic juvenile idiopathic arthritis","volume":"74","author":"Onel","year":"2022","journal-title":"Arthritis Rheumatol"},{"key":"2024110410415302900_R5","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1002\/acr.20497","article-title":"American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis","volume":"63","author":"Wallace","year":"2011","journal-title":"Arthritis Care Res"},{"key":"2024110410415302900_R6","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1136\/annrheumdis-2014-207164","article-title":"The risk and nature of flares in juvenile idiopathic arthritis: results from the ReACCh-Out cohort","volume":"75","author":"Guzman","year":"2016","journal-title":"Ann Rheum Dis"},{"key":"2024110410415302900_R7","doi-asserted-by":"crossref","first-page":"352","DOI":"10.3899\/jrheum.161078","article-title":"Attitudes and approaches for withdrawing drugs for children with clinically inactive nonsystemic JIA: a survey of the childhood arthritis and rheumatology research alliance","volume":"44","author":"Horton","year":"2017","journal-title":"J Rheumatol"},{"key":"2024110410415302900_R8","first-page":"229","article-title":"Strategies for the withdrawal of classic and biological DMARD in clinically inactive patients with juvenile idiopathic arthritis","volume":"45","author":"Azevedo","year":"2020","journal-title":"Acta Reumatol Port"},{"key":"2024110410415302900_R9","first-page":"399","article-title":"Juvenile idiopathic arthritis","volume":"72","author":"Takei","year":"2014","journal-title":"Jpn J Clin Med (In Japanese)"},{"key":"2024110410415302900_R10","doi-asserted-by":"crossref","first-page":"3727","DOI":"10.1093\/rheumatology\/keaa118","article-title":"Long-term outcomes and disease course of children with juvenile idiopathic arthritis in the ReACCh-Out cohort: a two-centre experience","volume":"59","author":"Chhabra","year":"2020","journal-title":"Rheumatology"},{"key":"2024110410415302900_R11","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1002\/acr.23853","article-title":"Long-term outcomes in juvenile idiopathic arthritis: eighteen years of follow-up in the population-based nordic juvenile idiopathic arthritis cohort","volume":"72","author":"Glerup","year":"2020","journal-title":"Arthritis Care Res"},{"key":"2024110410415302900_R12","first-page":"102","article-title":"Secondary Survey of Juvenile Idiopathic Arthritis (JIA) Using Specific Chronic Diseases in Childhood Data (in Japanese). Research on registration, management, evaluation, and information provision of specific chronic diseases in childhood treatment project","volume":"2008","author":"Takei","year":"2007","journal-title":"Collab Res Rep Fiscal Year"},{"key":"2024110410415302900_R13","first-page":"209","volume-title":"Textbook of Pediatric Rheumatology","author":"Petty","year":"2021","edition":"8th"},{"key":"2024110410415302900_R14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11926-015-0508-1","article-title":"The humanistic and economic burden of juvenile idiopathic arthritis in the era of biologic medication","volume":"17","author":"Gidman","year":"2015","journal-title":"Curr Rheumatol Rep"},{"key":"2024110410415302900_R15","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1001\/jama.2010.375","article-title":"Methotrexate withdrawal at 6 vs 12 months in juvenile idiopathic arthritis in remission: a randomized clinical trial","volume":"303","author":"Foell","year":"2010","journal-title":"Jama"},{"key":"2024110410415302900_R16","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1136\/annrheumdis-2017-211968","article-title":"Time spent in inactive disease before MTX withdrawal is relevant with regard to the flare risk in patients with JIA","volume":"77","author":"Klotsche","year":"2018","journal-title":"Ann Rheum Dis"},{"key":"2024110410415302900_R17","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1002\/acr.23435","article-title":"Flares after withdrawal of biologic therapies in juvenile idiopathic arthritis: clinical and laboratory correlates of remission duration","volume":"70","author":"Simonini","year":"2018","journal-title":"Arthritis Care Res"},{"key":"2024110410415302900_R18","first-page":"12","article-title":"Predictive factors of relapse after methotrexate discontinuation in juvenile idiopathic arthritis patients with inactive disease","volume":"1","author":"Azevedo","year":"2022","journal-title":"ARP Rheumatol"},{"key":"2024110410415302900_R19","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1002\/acr.22477","article-title":"Impact of medication withdrawal method on flare-free survival in patients with juvenile idiopathic arthritis on combination therapy","volume":"67","author":"Chang","year":"2015","journal-title":"Arthritis Care Res"},{"key":"2024110410415302900_R20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/14397595.2017.1352477","article-title":"Lymphoproliferative disorders in patients with rheumatoid arthritis in the era of widespread use of methotrexate: a review of the literature and current perspective","volume":"28","author":"Harigai","year":"2018","journal-title":"Mod Rheumatol"},{"key":"2024110410415302900_R21","first-page":"2290","article-title":"Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis","volume":"31","author":"Wallace","year":"2004","journal-title":"J Rheumatol"},{"key":"2024110410415302900_R22","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":"2024110410415302900_R23","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1002\/art.41879","article-title":"Definition and validation of the American College of Rheumatology 2021 juvenile arthritis disease activity score cutoffs for disease activity states in juvenile idiopathic arthritis","volume":"73","author":"Trincianti","year":"2021","journal-title":"Arthritis Rheumatol"},{"key":"2024110410415302900_R24","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1136\/annrheumdis-2011-201264","article-title":"Ultrasound-detected synovial abnormalities are frequent in clinically inactive juvenile idiopathic arthritis, but do not predict a flare of synovitis","volume":"72","author":"Magni-Manzoni","year":"2013","journal-title":"Ann Rheum Dis"},{"key":"2024110410415302900_R25","doi-asserted-by":"crossref","first-page":"851","DOI":"10.3899\/jrheum.170681","article-title":"Flares of disease in children with clinically inactive juvenile idiopathic arthritis were not correlated with ultrasound findings","volume":"45","author":"Zhao","year":"2018","journal-title":"J Rheumatol"},{"key":"2024110410415302900_R26","first-page":"1","article-title":"Patients with juvenile idiopathic arthritis in clinical remission with positive power Doppler signal in joint ultrasonography have an increased rate of clinical flare: a prospective study","volume":"15","author":"Miotto","year":"2017","journal-title":"Pediatr Rheumatol Online J"},{"key":"2024110410415302900_R27","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1136\/annrheumdis-2017-211696","article-title":"Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA)","volume":"77","author":"De Lucia","year":"2018","journal-title":"Ann Rheum Dis"},{"key":"2024110410415302900_R28","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s00247-017-4059-7","article-title":"Juvenile idiopathic arthritis: magnetic resonance imaging of the clinically unaffected knee","volume":"48","author":"van Gulik","year":"2018","journal-title":"Pediatr Radiol"},{"key":"2024110410415302900_R29","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s40272-019-00362-6","article-title":"Treatment withdrawal following remission in juvenile idiopathic arthritis: a systematic review of the literature","volume":"21","author":"Halyabar","year":"2019","journal-title":"Paediatr Drugs"},{"key":"2024110410415302900_R30","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1002\/acr.24129","article-title":"Making decisions about stopping medicines for well-controlled juvenile idiopathic arthritis: a mixed-methods study of patients and caregivers","volume":"73","author":"Horton","year":"2021","journal-title":"Arthritis Care Res (Hoboken)"}],"container-title":["Modern Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mr\/advance-article-pdf\/doi\/10.1093\/mr\/roae016\/57007221\/roae016.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mr\/article-pdf\/34\/6\/1231\/60412135\/roae016.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mr\/article-pdf\/34\/6\/1231\/60412135\/roae016.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T10:42:09Z","timestamp":1730716929000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mr\/article\/34\/6\/1231\/7619230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,5]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,3,5]]},"published-print":{"date-parts":[[2024,10,15]]}},"URL":"https:\/\/doi.org\/10.1093\/mr\/roae016","relation":{},"ISSN":["1439-7595","1439-7609"],"issn-type":[{"type":"print","value":"1439-7595"},{"type":"electronic","value":"1439-7609"}],"subject":[],"published-other":{"date-parts":[[2024,11]]},"published":{"date-parts":[[2024,3,5]]}}}