{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T05:54:04Z","timestamp":1791179644914,"version":"4.1.0"},"reference-count":24,"publisher":"The Journal of Rheumatology","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"accepted":{"date-parts":[[2026,6,22]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify the clinical characteristics associated with initial tumor necrosis factor inhibitor (TNFi) nonresponse in patients with juvenile spondyloarthritis (JSpA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective analysis of patients with JSpA enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry between July 2015 and January 2019 and their response to their first TNFi agent. The JSpA population included those with enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. Demographic and disease characteristics were compared at baseline visits prior to TNFi start and at the time of initial TNFi nonresponse or the visit closest to 6 months following TNFi start for the responders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Inclusion criteria were met by 286 patients; 168 were TNFi responders and 118 were TNFi nonresponders. Median time to TNFi nonresponse was 8.9 (IQR 5.3-14.2) months. Median age at TNFi start was similar for nonresponders (13.9 years) and responders (13.8 years;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.91). Nonresponders were more likely to be female (61.9% vs 48.2%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.02) and have a higher BMI (21.6 vs 19.2,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.02) and longer symptom duration (2.2 vs 1.4 years,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.04) compared to responders. Nonresponders had more clinical sacroiliitis and higher patient global assessment (PtGA) at baseline visit compared to responders (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.004 and\n                      <jats:italic>P<\/jats:italic>\n                      = 0.01, respectively). The majority were secondary nonresponders (113\/118, 96%). Most patients switched to a second TNFi (60.2%) following initial TNFi nonresponse.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Most nonresponders to TNFi had secondary nonresponse. Patients with JSpA who did not respond to initial TNFi were more likely to be female and have longer symptom duration prior to starting a TNFi, clinical sacroiliitis, and a higher BMI and higher PtGA scores at baseline. Patients with these features should be monitored more carefully for treatment response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3899\/jrheum.2026-0154","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:28:53Z","timestamp":1782908933000},"page":"1140-1146","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Disease Manifestations Associated With Tumor Necrosis Factor Inhibitor Nonresponse in Juvenile Spondyloarthritis"],"prefix":"10.3899","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7689-2573","authenticated-orcid":false,"given":"Melissa","family":"Oliver","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Mosesso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9724-0443","authenticated-orcid":false,"given":"Pamela F.","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6237-4575","authenticated-orcid":false,"given":"Robert A.","family":"Colbert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6225-3690","authenticated-orcid":false,"given":"Matthew L.","family":"Stoll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6714-4170","authenticated-orcid":false,"given":"Hemalatha","family":"Srinivasalu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"2026100422250789000_53.10.1140.1","first-page":"390","article-title":"International League of Associations for Rheumatology classification of juvenile idiopathic 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open-label, prospective study conducted at the National Scientific and Practical Center of Children\u2019s Health, Russia","volume":"15","author":"Alexeeva","year":"2017","journal-title":"Pediatr Rheumatol Online J"},{"key":"2026100422250789000_53.10.1140.12","doi-asserted-by":"crossref","first-page":"e222312","DOI":"10.1001\/jamanetworkopen.2022.2312","article-title":"Predicting probability of response to tumor necrosis factor inhibitors for individual patients with ankylosing spondylitis","volume":"5","author":"Wang","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026100422250789000_53.10.1140.13","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.120642"},{"key":"2026100422250789000_53.10.1140.14","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12969-017-0160-6","article-title":"The new Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry: design, rationale, and characteristics of patients enrolled in the first 12 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anti-TNF-naive patients with active luminal Crohn\u2019s disease: a prospective, multicentre, cohort study","volume":"4","author":"Kennedy","year":"2019","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026100422250789000_53.10.1140.21","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1093\/ibd\/izae165","article-title":"Effect of overweight and obesity on the response to anti-TNF therapy and disease course in children with IBD","volume":"31","author":"Sila","year":"2025","journal-title":"Inflamm Bowel Dis"},{"key":"2026100422250789000_53.10.1140.22","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1177\/1060028019900660","article-title":"Associations between obesity and the effectiveness of anti\u2013tumor necrosis factor-\u03b1 agents in inflammatory bowel disease patients: a literature review and meta-analysis","volume":"54","author":"Dai","year":"2020","journal-title":"Ann 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