Clinically inactive disease in a cohort of children with new-onset polyarticular juvenile idiopathic arthritis treated with early aggressive therapy: time to achievement, total duration, and predictors.
OBJECTIVE
To determine the elapsed time while receiving aggressive therapy to the first observation of clinically inactive disease (CID), total duration of CID and potential predictors of this response in a cohort of children with recent onset of polyarticular juvenile idiopathic arthritis (poly-JIA).


METHODS
Eighty-five children were randomized blindly to methotrexate (MTX), etanercept, and rapidly tapered prednisolone (MEP) or MTX monotherapy and assessed for CID over 1 year of treatment. Patients who failed to achieve intermediary endpoints were switched to open-label MEP treatment.


RESULTS
Fifty-eight (68.2%) of the 85 patients achieved CID at 1 or more visits including 18 who received blinded MEP, 11 while receiving MTX monotherapy, and 29 while receiving open-label MEP. Patients starting on MEP achieved CID earlier and had more study days in CID compared to those starting MTX, but the differences were not significantly different. Patients given MEP (more aggressive therapy) earlier in the disease course were statistically more likely to have a higher proportion of followup visits in CID than those with longer disease course at baseline. Those who achieved American College of Rheumatology Pediatric 70 response at 4 months had a significantly greater proportion of followup visits in CID, compared to those who failed to achieve this improvement (p < 0.0001). Of the 32 patients who met criteria for CID and then lost CID status, only 3 fulfilled the definition of disease flare.


CONCLUSIONS
Shorter disease duration prior to treatment, a robust response at 4 months, and more aggressive therapy result in a higher likelihood and longer duration of CID in patients with poly-JIA. The original trial from which data for this analysis were obtained is registered on www.clinicaltrials.gov NCT 00443430.
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Carol A
CA
Wallace
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Edward H
EH
Giannini
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Steven J
SJ
Spalding
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Philip J
PJ
Hashkes
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Kathleen M
KM
O'Neil
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Andrew S
AS
Zeft
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Ilona S
IS
Szer
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Sarah
S
Ringold
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Hermine I
HI
Brunner
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Laura E
LE
Schanberg
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Robert P
RP
Sundel
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Diana S
DS
Milojevic
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Marilynn G
MG
Punaro
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Peter
P
Chira
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Beth S
BS
Gottlieb
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Gloria C
GC
Higgins
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Norman T
NT
Ilowite
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Yukiko
Y
Kimura
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Anne
A
Johnson
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Bin
B
Huang
From the Seattle Children's Hospital and Research Institute, Seattle, Washington; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati; Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indianapolis; Rady Children's Hospital, San Diego, California; Duke University Medical Center, Durham, North Carolina; Children's Hospital of Boston; Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, Texas; Hofstra North Shore-LIJ School of Medicine, New York, New York; Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Children's Hospital at Montefiore, New York, New York; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; E.H. Giannini, MSc, DrPH; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; S.J. Spalding, MD, Cleveland Clinic; P.J. Hashkes, MD, MSc, Shaare Zedek Medical Center; K.M. O'Neil, MD, Riley Hospital for Children, Indiana University School of Medicine; A.S. Zeft, MD, Cleveland Clinic; I.S. Szer, MD, Rady Children's Hospital; L.E. Schanberg, MD, Duke University Medical Center; R.P. Sundel, MD, Children's Hospital of Boston; D. Milojevic, MD, Floating Hospital for Children, Tufts Medical Center; M.G. Punaro, MD, Texas Scottish Rite Hospital; P. Chira, MD, Riley Hospital for Children, Indiana University School of Medicine; B.S. Gottlieb, MD, MS, Hofstra North Shore-LIJ School of Medicine; G.C. Higgins, PhD, MD, The Ohio State University and Nationwide Children's Hospital; N.T. Ilowite, MD, Children's Hospital at Montefiore; Y.
Daniel J
DJ
Lovell
D000293:Adolescent; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D011239:Prednisolone / Q000627:therapeutic use*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012074:Remission Induction; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D011239:Prednisolone; D000068800:Etanercept; D008727:Methotrexate
CHILDREN 2–16 YEARS; CLINICAL TRIAL; CLINICALLY INACTIVE DISEASE; EARLY AGGRESSIVE THERAPY; JUVENILE IDIOPATHIC ARTHRITIS