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            "entidad" => "Hospital Universitario Virgen de las Nieves&#44; Granada&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
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            "entidad" => "Hospital Universitario de Canarias&#44; La Laguna&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
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            "entidad" => "Hospital Universitario Virgen del Roc&#237;o&#44; Sevilla&#44; Spain"
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            "entidad" => "Hospital Universitario Infantil Ni&#241;o Jes&#250;s&#44; Madrid&#44; Spain"
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            "entidad" => "Complexo Hospitalario Universitario A Coru&#241;a&#44; A Coru&#241;a&#44; Spain"
            "etiqueta" => "i"
            "identificador" => "aff0045"
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            "entidad" => "Hospital Universitario 12 de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "j"
            "identificador" => "aff0050"
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            "entidad" => "Hospital Cl&#237;nico Universitario Virgen de la Arrixaca&#44; Murcia&#44; Spain"
            "etiqueta" => "k"
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            "entidad" => "Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain"
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            "entidad" => "Hospital de Cruces&#44; Baracaldo&#44; Spain"
            "etiqueta" => "m"
            "identificador" => "aff0065"
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            "entidad" => "Hospital Universitario Vall d&#8217;Hebron&#44; Barcelona&#44; Spain"
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            "entidad" => "Hospital Universitario Virgen Macarena&#44; Sevilla&#44; Spain"
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            "entidad" => "Hospital Sant Joan de D&#233;u&#44; Esplugues de Llobregat&#44; Spain"
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        "titulo" => "Modelo de elecci&#243;n discreta para entender la decisi&#243;n de optimizar los biol&#243;gicos en la artritis idiop&#225;tica juvenil"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Steps taken in the methodology to reach the objectives&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">During the last decades&#44; the treatment and prognosis of patients with juvenile idiopathic arthritis &#40;JIA&#41; have changed dramatically&#46; The introduction of biologic agents coupled by the implementation of agile strategies for monitoring and taking decisions are behind the success&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Biological dose reduction &#8211; also called tapering&#44; de-escalation&#44; adjustment&#44; optimisation&#44; or spacing &#8211; is a widespread practice among paediatric rheumatologists&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> However&#44; the evidence on the maintenance of remission or long-term effects after tapering biologics in JIA is scarce&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> In addition&#44; this decision&#44; taken in clinical practice&#44; is subject to large variability&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Previous experiences on how to taper biological therapies in adults&#44; such as the one carried out by the Spanish Society of Rheumatology &#40;SER&#41; with the REDOSER consensus&#44; have identified patient but not drug-related attributes leading to appropriate tapering&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> The main concern of tapering is relapse&#44; which is not negligible&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> Some of the factors that may play a role in maintaining remission after dose reduction include length of remission&#44; or the absence of subclinical disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3&#44;6&#8211;8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The problems of the paediatric rheumatic population treated with biologics are different from the adult rheumatic population in terms of dosage&#44; efficacy&#44; or the time remaining on the medication&#44; for instance&#46; How to make a dose adjustment does not raise serious questions of evidence&#44; but rather of pharmacokinetics and presentation&#44; which could be extrapolated from adults&#46; However&#44; two more specific problems do arise&#46; On the one hand the reasons&#8212;and fears or reticence&#8212;for which a paediatrician would initiate dose reduction&#44; and on the other&#44; whom should be reduced&#44; taking into account prognostic factors&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Discrete-choice experiments&#44; or conjoint analysis&#44; are a methodology employed in health economics to quantify preferences for medicines and services but can also be used to understand patient preferences for health states&#44; willingness to accept therapeutic risks&#44; and decision making&#44; and can also be used to understand clinical decision making&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> These methods have been previously used in Rheumatology&#44; among others&#44; to comprehend patient preferences<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> and to understand the decision to escalate care in rheumatoid arthritis&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> and so our team thought it could be an adequate methodology to disentangle the decision to taper down biologics in JIA&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this initiative was thus to identify factors involved in the decision to taper disease modifying drugs &#40;DMARD&#41;&#44; being these biological or not&#44; in children and youngsters with JIA&#44; and to quantify their value in the clinical decision-making&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">This is a mixed-methods study&#46; The methodological approach was carried out in different and successive phases&#58; &#40;1&#41; creation of an expert panel that underwent nominal group techniques to elaborate the conceptual model of the dose reduction process&#44; and to start defining factors involved in this process&#59; &#40;2&#41; ratification and addition of factors or levels of factors by a broader group&#59; and &#40;3&#41; discrete-choice experiment to calculate the utility and weights that physicians assign to the factors involved in reducing or not the dose of DMARDs &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Expert&#39;s selection and nominal group</span><p id="par0040" class="elsevierStylePara elsevierViewall">A scientific committee was established with a national representative panel of specialists with proven expertise in JIA management&#46; The selection of experts &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41; was based on their membership of the scientific committee of the Spanish Society of Paediatric Rheumatology &#40;SERPE&#41; and for being heads of the paediatric rheumatology units of university hospitals of recognised prestige and experience&#46; In a face to face meeting with methodologists&#44; nominal group techniques were used to define the process of dose reduction&#44; or interval spacing&#44; in children with JIA in treatment with biologics and their decision nodes&#46; Nominal group techniques imply preparing the concept &#40;in this case&#44; the process of adjusting biologics&#41; before the meeting&#44; having time to think in silence during the meeting&#44; writing down thoughts&#44; and then sharing them out loud&#46; A methodologist expert in this technique made sure that everybody had a chance to present their thoughts and to express their opinions about the others&#8217;&#46; The meeting was organised in two parts&#44; one to understand the process of drug adjustment&#44; and the second to detail what things would change the mind of the expert when adjusting&#46; Brainstorm dynamics were used to elicit factors that could determine dose adjustment at each decision node&#46; The methodologist encouraged discussions&#44; item by item&#44; to make sure the experts had experienced a case&#44; or could think of one&#44; in which a specific patient or drug factor changed their mind of adjusting the dose or not&#46; In addition&#44; potential levels or categories for each factor were started to be defined &#40;e&#46;g&#46;&#44; if age were a factor&#44; the levels could be &#8220;2 years of age or under&#8221; and &#8220;over 2 years&#8221;&#41;&#46; This methodology does not require recording or transcription of discourse&#46; The process map and all items were presented in real time during the meeting in whiteboards and in mind maps to be cross-checked with the experts and notes were taken&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ratification by a broader group</span><p id="par0045" class="elsevierStylePara elsevierViewall">After the first meeting&#44; the map&#44; nodes&#44; and factors were explained to a broader group of &#8776;50 paediatric rheumatologists during a national meeting of the paediatric rheumatology group&#44; at which the previous factors or attributes were ratified&#44; more factors were collected&#44; these were better defined&#44; and levels of the factors further specified&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In both meetings all decisions to include or not to include were taken by unanimity&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discrete-choice experiment &#40;DCE&#41;</span><p id="par0055" class="elsevierStylePara elsevierViewall">This methodology allows to understand the factors that influence the physician&#39;s preferences at the time of reducing or spacing the doses&#46; DCE consists of a survey with several screens presenting two hypothetical clinical scenarios in which the cases are defined each by two alternatives &#40;defined by the factors elicited in previous phases&#41; with varying attribute levels &#40;the categories of factors previously defined&#41;&#46; An example of these scenarios is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; At each pair of scenarios respondents had to decide in which case&#44; or both or none&#44; they would take the decision&#46; Three DCE surveys were created using the 1000Minds&#174; software&#46; Each of the surveys were defined by a decision node &#40;wait&#44; reduce&#47;space&#44; adjust biologic&#41;&#46; The items of the surveys&#44; i&#46;e&#46;&#44; the pairs of scenarios&#44; were created automatically by the programme after feeding it with all the factors and their corresponding levels&#46; Impossible scenarios were deleted with the help of an expert &#40;SM&#41;&#46; The surveys were then sent to the panel of 17 experts&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">A conjoint analysis was used&#46; This statistical technique makes possible to determine which combination of a limited number of attributes has the highest value in a decision<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12&#44;13</span></a>&#46; The result of each selection of hypothetical scenarios is recorded as a rating contingent attached to attributes-levels in the scenarios presented&#44; and an order from the most valued to the least valued &#40;contingent ranking&#41;&#46; The statistics&#44; automatically calculated by the software used &#40;1000Minds&#174;&#41;&#44; were the partial-value functions&#8212;i&#46;e&#46;&#44; the utility that physicians assign to the levels of each attribute&#8212;and the weights of relative importance&#8212;i&#46;e&#46;&#44; which attributes exert a considerable influence on choice&#46; With these values&#44; it is possible to define rankings&#44; i&#46;e&#46;&#44; a value-ordered list of the factors that influence decisions&#44; and weights&#44; i&#46;e&#46;&#44; a measure of the magnitude of the influence&#46; Rankings and weights are both valid ways to present the results&#44; although they are not exchangeable&#59; however&#44; one can easily understand that between two magnitudes of influence&#44; the largest will rank higher&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The panel was composed by 6 men and 11 women&#44; with ages between 32 and 65&#44; being 8 paediatricians&#44; 8 rheumatologists who attended adults and children&#44; and 1 who had both specialities and attended only children currently&#46; All were actively practicing in university hospitals and had access to transition policies and procedures&#46; As part of the criteria&#44; they were all experts in the boards of rheumatology and&#47;or paediatrics associations and had a minimum 5-year experience with biologics&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Process map and decision nodes</span><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows the dose modification process map as discussed in the expert group with the three decision nodes identified&#46; Experts agreed that the entire process begins when a patient arrives at &#8220;remission with treatment&#8221; for at least 6 months&#44; a situation which is well defined by the Wallace criteria &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The first node implies postponing the decision &#40;for an undetermined time&#41; or not&#59; the second decision node would be to modify the dose&#47;interval or not&#59; and the third decision node would be how to modify therapy&#46; A fourth decision was identified in the longer term&#44; when a patient achieves 12 months of remission with optimised treatment&#44; but it was agreed by the panel that this decision was far too complex for this initiative given that there are many modification options available&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Factors determining decisions</span><p id="par0080" class="elsevierStylePara elsevierViewall">In decision node 1 &#40;&#8220;Postpone decision to optimise&#8221;&#41;&#44; and after the two rounds of consultation &#40;small and broader group of experts&#41;&#44; the following factors were identified&#58; systemic or polyarticular predominance&#44; macrophage activation syndrome &#40;MAS&#41; in the past&#44; requirement of two or more treatments to be controlled or previous relapse while lowering the dose&#44; time needed to achieve remission&#44; subclinical inflammation &#40;laboratory or imaging&#41;&#44; involvement of joints difficult to control&#44; tenosynovitis&#44; uveitis&#44; early debut &#40;below the age of four&#41;&#44; and axial involvement&#46; Experts agreed in that these factors did not apply equally to all types of JIA &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The panel of experts established in the first meeting&#44; by consensus&#44; that the results should apply to the different JIA subtypes&#44; grouped for this exercise purposes into&#58; &#8220;systemic&#8221;&#44; &#8220;polyarticular RF&#43;&#8221;&#44; &#8220;oligoarticular and polyarticular RF negative&#8221;&#44; &#8220;arthritis-related enthesitis&#8221; and &#8220;psoriatic arthritis&#8221;&#46; This information was used to prepare the scenarios and delete the impossible ones&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In the second decision node &#40;&#8220;maintain or modify&#8221;&#41; the factors affecting the decision are not so clearly related to patient attributes but to the drug&#44; e&#46;g&#46;&#44; whether the drug is given in monotherapy or has produced immunogenicity&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the third node &#40;&#8220;how&#8221;&#41;&#44; the experts identified the factors affecting the choice of drug to reduce&#44; biologic or non-biologic&#46; This node occurs immediately after the second node&#44; or simultaneously&#46; The factors affecting this decision that were elicited from the discussions were immunogenicity&#44; adherence&#44; and MTX tolerance&#46; Further structure for the &#8220;how to&#8221; decision is presented in a supplementary file&#44; as it was decided not to include given its complexity&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">At the second meeting&#44; the broader group ratified the previous attributes&#44; added a few and defined each attribute and the levels of each factor &#40;final list used in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results from conjoint analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the criterion ranking of the factors involved in the first decision node&#46; To interpret it&#44; the greater the ranking &#40;1&#8211;14&#41;&#44; the less difficulty or doubt to make the decision&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The participants mentioned that the presence of uveitis did not clarify the scenario and that they would have needed to know more about the specific case&#44; such as whether the episode occurred while on treatment&#44; or treatment required to control uveitis &#40;topical&#44; systemic&#44; etc&#46;&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In node 2 &#40;&#8220;to modify or not&#8221;&#41; the two attributes investigated showed a very similar weight &#40;in this case the ranking had less meaning as there were only two attributes&#41;&#44; although the presence of antidrug antibodies made the choice of modifying simpler &#40;weight 6&#41; than if the patient is with more than one drug &#40;combined therapy&#41; for the control of the disease &#40;weight 4&#41;&#46; It was mentioned that it may depend on the biologic agent used&#44; as not all have the same antibody profile&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In node 3 &#40;&#8220;which drug regimen to modify and how&#8221;&#41;&#44; the same situation occurred&#44; the attributes had a similar weight&#44; although the presence of previous toxicity with MTX made the choice simpler &#40;weight 6&#41; than low adherence &#40;weight 4&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">An analysis of attributes by specialty showed no differences or patterns between the preferences of paediatricians &#40;who practice rheumatology&#41; and rheumatologists &#40;who attend children&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">Results show that&#44; for experts in the use of biologics in JIA&#44; the decision is clear when the patient has had a MAS&#44; or systemic involvement&#44; or subclinical inflammation&#44; either analytical or by image&#44; even if at present the patient has been on remission for the last 6 months&#46; The preferred decision was&#44; in all these cases&#44; to postpone or to avoid optimisation&#46; Interestingly enough&#44; other aspects identified by experts as modifying their decisions were not really influencing it&#44; especially the involvement of joints difficult to control or age at debut&#46; Other aspects had different effect when confronted to experts as part of hypothetical scenarios&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The vast majority of randomised controlled trials of biological therapies in children have a phase in which withdrawal is implemented once remission is achieved&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">7&#44;15&#8211;20</span></a> This reflects common practice in paediatric rheumatology&#44; where medications are discontinued as soon as possible to avoid long-term complications&#46; This has led to an &#8220;art of optimisation&#8221;&#44; with each paediatric rheumatologist taking different decisions or using different factors to support them&#46; While variability is not per se unwanted&#44; when it exists&#44; it should be based on solid grounds of proven efficacious and safe options&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> As Halyabar et al&#46; nicely summarised in their systematic review&#44; the disease is heterogeneous&#44; the definition of inactivity is heterogeneous&#44; disease management is heterogeneous&#44; consequently&#44; &#8220;decisions often revolve around perceptions of the relative risks of continuing versus stopping treatment&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Several studies&#44; many small&#44; most retrospective&#44; have studied outcomes of children with JIA who discontinued therapies after achieving inactive disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#44;5&#8211;7</span></a> Evidence shows that flares are common after discontinuation&#44; ranging from 30 to 100&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> This is one of the reasons why optimisation rather than withdrawal is attempted&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2&#44;7&#44;21</span></a> However&#44; optimisation is not as well studied as withdrawal&#44; neither are factors influencing outcome&#44; and paediatric rheumatologists do not have a guidance on how to actually do it with guarantees in JIA&#44; as it is the case with adults&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">We are confident in that the results reflect actual mental processes based on experience&#46; The discrete-choice method interrogates highly experienced individuals and confront them with a set of hypothetical scenarios with several levels of two or more attributes and ask them to choose the one they prefer &#40;choice experiment&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a> This method identifies preferences and factors influencing decisions more efficiently than real data&#44; at least with feasible numbers and wealth of factors&#46; This methodology also has some drawbacks&#46; Respondents use simplification strategies when facing many options&#44; when the reality is that the situation in front of a patient is far more complex than two variables at a time&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a> Experts would have wanted more information and more options&#44; as shown by their comments on uveitis&#44; for example&#46; Also&#44; the experts responding the survey could have used simplification strategies&#44; for instance&#44; always choosing conservative options&#44; a limitation we cannot rule out with this design&#46; However&#44; our intention was to identify the factors that most plausibly influence the decision and to rank them&#44; rather than obtaining a composite weighted score or similar output&#46; We cannot discard that&#44; in the future&#44; the understanding of decisions could be better carried out with some method using artificial intelligence&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> Currently&#44; this is the most adequate methodology we could think of to help guiding decisions of non-experts&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In our initiative&#44; we have attempted to study the decision process by first having experts discussing on their experiences and studies&#44; then by testing the factors they think they use in their decisions to weight the importance in the decision&#46; This experiment found no sociodemographic factors determining decisions&#44; while in many studies these are the first factors to study&#44;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4&#44;6&#44;7&#44;23</span></a> and identified other factors that should now be tested or used for studies in the long term&#46; The discussions were extremely rich and factors that appeared initially as determinants&#44; then faded away when seen on light of other factors&#44; e&#46;g&#46;&#44; comorbidity&#44; like psoriasis or inflammatory bowel disease were put forward as factors in a first step&#44; but when the classification into four groups was established as well as the starting point of remission&#44; they disappeared as relevant for the decision to taper&#46; It could be argued that the number of experts was low and that the survey should have had many more respondents&#46; Given the complexity of the clinical decision making in this specific situation&#44; our resolution was to weight expertise more than sample size&#44; as the final aim was to use these results to inform recommendations on the adjustment of biologics in JIA&#46; Also&#44; not including experts from other countries was determined to facilitate discussions in a common language in which all were fluid&#44; as our experience is that Spanish experts are excellent clinicians but do not participate comfortably in international panels due to language constrictions&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The next steps will be to study the appropriateness of each optimisation strategy &#40;continuation of decision node 3&#41;&#44; but this will require a different approach&#46; Our aim for a second step is to review the literature on available options on how to taper biologics&#44; and to run a national survey&#44; targeted at paediatric rheumatologists&#44; on tapering practices&#46; Ideally&#44; we should design large observational studies to compare the different options&#44; but this is not easy in the context of rare diseases&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In summary&#44; the decision to optimise the dose of biological therapy in children and youngsters can be granulated into several nodes&#44; and the factors&#44; both patient and therapy-related&#44; leading to the decision can be detailed&#46; These decisions taken by experts may be transported to practice&#44; study designs&#44; and guidelines&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Data sharing statement</span><p id="par0160" class="elsevierStylePara elsevierViewall">Data are available upon request&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Authors&#8217; contributions</span><p id="par0165" class="elsevierStylePara elsevierViewall">SM designed&#44; coordinated&#44; analysed and wrote the manuscript&#59; AB&#44; IC&#44; EN&#44; BB&#44; SB&#44; MC&#44; DC&#44; JG&#44; JdI&#44; LLC&#44; PMC&#44; JCNG&#44; MCP&#44; EQ&#44; CV&#44; and JA contributed to the discussions&#44; answered the discrete choice surveys and helped in the preparation of the manuscript&#46; All authors revised the last version&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Ethical approval and patient and public involvement</span><p id="par0170" class="elsevierStylePara elsevierViewall">The nature of the study&#44; theoretical and with no inclusion of real patients&#8217; data&#44; does not make it necessary to undergo ethical review according to local regulations&#46; For its technical difficulty and given that all decisions are physician based&#44; patients or public were not involved in the project&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">The study was funded by the Spanish Society of Paediatric Rheumatology &#40;<span class="elsevierStyleGrantSponsor" id="gs1">SERPE</span>&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">S&#46;M reports grants from Spanish Paediatric Rheumatology Society&#59; A&#46;B has nothing to disclose&#59; I&#46;C&#46;P has nothing to disclose&#59; E&#46;N&#46;C reports grants from Spanish Paediatric Rheumatology Society&#59; B&#46;B reports grants from SERPE&#59; S&#46;B has nothing to disclose&#59; M&#46;C&#46;L reports grants from SERPE&#59; D&#46;C&#46; reports grants from Spanish Paediatric Rheumatology Society&#44; from null&#44; during the conduct of the study&#59; personal fees from Lectures for Abbvie&#44; Roche and Novartis&#44; outside the submitted work&#59; B&#46;B reports grants from SERPE&#59; J de I&#46; reports grants from Spanish Paediatric Rheumatology Society&#59; L&#46;L&#46; has nothing to disclose&#59; P&#46;M&#46;D&#46;C&#46; has nothing to disclose&#59; J&#46;C&#46;N&#46;G&#46; has nothing to disclose&#59; MC&#46;P&#46; reports grants from SERPE&#59; E&#46;Q-M has nothing to disclose&#59; C&#46;V&#46; reports other from Pfizer&#44; Abbie&#44; Roche&#44; Novartis&#44; UCB&#44; SERPE&#44; SER&#44; FISEVI&#59; J&#46;A&#46; reports grants from Spanish Paediatric Rheumatology Society&#46;</p></span></span>"
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    "fechaRecibido" => "2021-04-26"
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            0 => "Juvenile idiopathic arthritis"
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            0 => "Artritis idiop&#225;tica juvenil"
            1 => "Terapias biol&#243;gicas"
            2 => "Optimizaci&#243;n"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyse factors involved in the decision to optimise biologics in juvenile idiopathic arthritis&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A &#8220;discrete-choice&#8221; methodology was used&#46; In a nominal group meeting&#44; factors which may influence physicians&#8217; decisions to optimise biological dose were identified&#44; together with decision nodes&#46; 1000Minds&#174; was used to create multiple fictitious clinical scenarios based on the factors identified&#44; and to deploy surveys that were sent to a panel of experts&#46; These experts decided for each item which of two clinical scenarios prompted them to optimise the dose of biologic&#46; A conjoint analysis was carried out&#44; and the partial-value functions and the weights of relative importance calculated&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In the nominal group&#44; three decision nodes were identified&#58; &#40;1&#41; time to decide&#59; &#40;2&#41; to maintain&#47;reduce or prolong interval&#59; &#40;3&#41; what drug to reduce&#46; The factors elicited were different for each node and included patient and drug attributes&#46; The presence of macrophage activation syndrome &#40;MAS&#41;&#44; systemic involvement&#44; or subclinical inflammation made the decision easier &#40;highest weights&#41;&#46; The presence of joints of difficult control and year of debut influenced the decision in some but not all&#44; and in different directions&#46; Immunogenicity&#44; adherence&#44; and concomitant treatments were also aspects taken into account&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The decision to optimise the dose of biological therapy in children and youngster can be divided into several nodes&#44; and the factors&#44; both patient and therapy-related&#44; leading to the decision can be detailed&#46; These decisions taken by experts may be transported to practice&#44; study designs&#44; and guidelines&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar los factores que intervienen en la decisi&#243;n de optimizar el biol&#243;gico en la artritis idiop&#225;tica juvenil&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se utiliz&#243; la metodolog&#237;a de &#171;elecci&#243;n discreta&#187;&#46; Mediante grupo nominal se identificaron factores potencialmente influyentes en la decisi&#243;n de optimizar la dosis de biol&#243;gico y los nodos de decisi&#243;n&#46; Con 1000Minds&#174; se crearon escenarios cl&#237;nicos ficticios basados en los factores identificados que se mostraron en encuestas a un panel de expertos&#46; Cada &#237;tem de las encuestas mostraba 2 escenarios cl&#237;nicos y los expertos eleg&#237;an el que les llevar&#237;a a optimizar el biol&#243;gico&#46; Se realiz&#243; un an&#225;lisis conjunto&#44; calcul&#225;ndose las funciones de valor parcial y los pesos de importancia relativa&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se identificaron 3 nodos de decisi&#243;n&#58; 1&#41; dilatar decisi&#243;n o no&#59; 2&#41; mantener&#47;reducir o prolongar el intervalo&#59; y 3&#41; qu&#233; f&#225;rmaco reducir&#46; Los factores identificados var&#237;an por nodo e incluyen atributos del paciente y del f&#225;rmaco&#46; La presencia del s&#237;ndrome de activaci&#243;n macrof&#225;gica&#44; la afectaci&#243;n sist&#233;mica o la inflamaci&#243;n subcl&#237;nica facilitaron la decisi&#243;n &#40;pesos m&#225;s altos&#41;&#46; La presencia de articulaciones de dif&#237;cil control y el a&#241;o de inicio influyeron en la decisi&#243;n en algunos casos&#44; pero no en todos&#44; y en diferentes direcciones&#46; La inmunogenicidad&#44; la adherencia y los tratamientos concomitantes tambi&#233;n fueron aspectos decisivos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La decisi&#243;n de optimizar la dosis de biol&#243;gico en artritis idiop&#225;tica juvenil se divide en varios nodos y se pueden detallar factores&#44; tanto del paciente como del tratamiento&#44; que determinan la decisi&#243;n&#46; Estas decisiones de experto pueden transportarse a la pr&#225;ctica&#44; la investigaci&#243;n y las recomendaciones&#46;</p></span>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Process map of treatment and dose adjustment in JIA&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Based on the Wallace criteria&#44; a child or youngster with JIA is in remission if&#58;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- No arthritis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- No fever&#44; no rash&#44; no serositis&#44; no lymph nodes or myalgias attributable to the disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- No active uveitis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Normal acute phase reactants &#40;PCR and VSG&#41;&#44; or elevated by causes not attributable to JIA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Morning stiffness<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- No activity by any scale used by the professional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Four possible situations&#58;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#46; Active disease&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">For remission with treatment in psoriatic arthritis&#44; the skin must have no lesions&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Definition of &#8220;remission on and off treatment&#8221;&#46;</p>"
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      ]
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            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Attributes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Classification</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Systemic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Polyarticular RF&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Oligo-polyarticular RF&#8722; or psoriatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Enthesitic-related arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systemic predominance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polyarticular predominance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Has required 2 or more treatments or has previously relapsed while lowering the dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time to remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subclinical inflammation &#40;laboratory&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subclinical inflammation &#40;imaging&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Difficult to control joints&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tenosynovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early debut &#40;age<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Axial involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Factors that may lead to postponing the decision to modify dose&#46; As elicited from experts discussions of experiences&#44; by type of JIA&#46;</p>"
        ]
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        "tabla" => array:2 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Node&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Factors&#47;attributes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Levels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systemic involvement<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&#46; joints&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;&#61;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rheumatoid factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAS<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Has presented it in the past&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Has not presented it&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&#46; treatments needed to reach remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st DMARD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 DMARD then 1st biologic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 or more biologics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time to remission<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;&#61;1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subclinical inflammation &#40;laboratory&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subclinical inflammation &#40;imaging&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal ultrasound&#44; including Power-Doppler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Power-Doppler signal in joint or tendon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Joints difficult to control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Temporomandibular joint&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carpal synovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tarsal-sub astragalin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hips&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carpal tenosynovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uveitis<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;2 episodes&#44; without complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;&#61;2 episodes&#44; without complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">With complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early debut &#40;&#60;4 years old&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset &#60;4&#47;onset &#62;&#61;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Axial involvement<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Axial involvement&#47;no axial involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Monotherapy<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Monotherapy&#47;combined therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Immunogenicity<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">h</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unknown drug levels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Undetectable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anti-drug antibodies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3rd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adherence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor&#47;good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methotrexate intolerance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                      "titulo" => "Attitudes and approaches for withdrawing drugs for children with clinically inactive nonsystemic JIA&#58; a survey of the childhood arthritis and rheumatology research alliance"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46; Cai"
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                            2 => "W&#46; Zhang"
                            3 => "J&#46; Xu"
                            4 => "L&#46; Cao"
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                      "titulo" => "Defining juvenile idiopathic arthritis remission and optimum time for disease-modifying anti-rheumatic drug withdrawal&#58; why we need a consensus"
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                          "etal" => false
                          "autores" => array:2 [
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                      "doi" => "10.2165/11595980-000000000-00000"
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                      "titulo" => "Spanish Rheumatology Society and Hospital Pharmacy Society Consensus on recommendations for biologics optimization in patients with rheumatoid arthritis&#44; ankylosing spondylitis and psoriatic arthritis"
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                          "etal" => true
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                            2 => "B&#46; Dorantes-Calderon"
                            3 => "R&#46; Garcia-Vicuna"
                            4 => "B&#46; Hernandez-Cruz"
                            5 => "A&#46; Herrero-Ambrosio"
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                      "doi" => "10.1093/rheumatology/keu461"
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                        "volumen" => "54"
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                      "titulo" => "Treatment withdrawal following remission in juvenile idiopathic arthritis&#58; a systematic review of the literature"
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                          "autores" => array:5 [
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                            2 => "S&#46; Ringold"
                            3 => "D&#46;G&#46; Rumsey"
                            4 => "D&#46;B&#46; Horton"
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                    0 => array:2 [
                      "titulo" => "Clinical outcomes after withdrawal of anti-tumor necrosis factor alpha therapy in patients with juvenile idiopathic arthritis&#58; a twelve-year experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Baszis"
                            1 => "J&#46; Garbutt"
                            2 => "D&#46; Toib"
                            3 => "J&#46; Mao"
                            4 => "A&#46; King"
                            5 => "A&#46; White"
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                    0 => array:2 [
                      "doi" => "10.1002/art.30502"
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                        "paginaFinal" => "3168"
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                0 => array:2 [
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                      "titulo" => "Impact of medication withdrawal method on flare-free survival in patients with juvenile idiopathic arthritis on combination therapy"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;Y&#46; Chang"
                            1 => "R&#46;M&#46; Meyer"
                            2 => "A&#46;O&#46; Reiff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/acr.22477"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
                        "fecha" => "2015"
                        "volumen" => "67"
                        "paginaInicial" => "658"
                        "paginaFinal" => "666"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25220674"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0155"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Flares after withdrawal of biologic therapies in juvenile idiopathic arthritis&#58; clinical and laboratory correlates of remission duration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Simonini"
                            1 => "G&#46; Ferrara"
                            2 => "I&#46; Pontikaki"
                            3 => "E&#46; Scoccimarro"
                            4 => "T&#46; Giani"
                            5 => "A&#46; Taddio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Conjoint analysis applications in health &#8211; a checklist&#58; a report of the ISPOR Good Research Practices for Conjoint Analysis Task Force"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Bridges"
                            1 => "A&#46;B&#46; Hauber"
                            2 => "D&#46; Marshall"
                            3 => "A&#46; Lloyd"
                            4 => "L&#46;A&#46; Prosser"
                            5 => "D&#46;A&#46; Regier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Value Health"
                        "fecha" => "2011"
                        "volumen" => "14"
                        "paginaInicial" => "403"
                        "paginaFinal" => "413"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient preferences regarding rheumatoid arthritis therapies&#58; a conjoint analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;M&#46; Louder"
                            1 => "A&#46; Singh"
                            2 => "K&#46; Saverno"
                            3 => "J&#46;C&#46; Cappelleri"
                            4 => "A&#46;J&#46; Aten"
                            5 => "A&#46;S&#46; Koenig"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Health Drug Benefits"
                        "fecha" => "2016"
                        "volumen" => "9"
                        "paginaInicial" => "84"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27668050"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors that influence rheumatologists&#8217; decisions to escalate care in rheumatoid arthritis&#58; results from a choice-based conjoint analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46; Kievit"
                            1 => "L&#46; van Hulst"
                            2 => "P&#46; van Riel"
                            3 => "L&#46; Fraenkel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/acr.20123"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
                        "fecha" => "2010"
                        "volumen" => "62"
                        "paginaInicial" => "842"
                        "paginaFinal" => "847"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20535795"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What should be the cut point for classification criteria of studies in gout&#63; A conjoint analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Fransen"
                            1 => "W&#46; Kievit"
                            2 => "T&#46; Neogi"
                            3 => "R&#46; Schumacher"
                            4 => "T&#46; Jansen"
                            5 => "N&#46; Dalbeth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
                        "fecha" => "2016"
                        "volumen" => "68"
                        "paginaInicial" => "1731"
                        "paginaFinal" => "1735"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pros and cons of conjoint analysis of discrete choice experiments to define classification and response criteria in rheumatology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;J&#46; Taylor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/BOR.0000000000000259"
                      "Revista" => array:7 [
                        "tituloSerie" => "Curr Opin Rheumatol"
                        "fecha" => "2016"
                        "volumen" => "28"
                        "paginaInicial" => "117"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26780423"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109721049688"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Childhood Arthritis and Rheumatology Research Alliance&#59; Pediatric Rheumatology International Trials Organization&#59; Pediatric Rheumatology Collaborative Study Group"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;A&#46; Wallace"
                            1 => "N&#46; Ruperto"
                            2 => "E&#46; Giannini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2004"
                        "volumen" => "31"
                        "paginaInicial" => "2290"
                        "paginaFinal" => "2294"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Abatacept in children with juvenile idiopathic arthritis&#58; a randomised&#44; double-blind&#44; placebo-controlled withdrawal trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Ruperto"
                            1 => "D&#46;J&#46; Lovell"
                            2 => "P&#46; Quartier"
                            3 => "E&#46; Paz"
                            4 => "N&#46; Rubio-Perez"
                            5 => "C&#46;A&#46; Silva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(08)60998-8"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2008"
                        "volumen" => "372"
                        "paginaInicial" => "383"
                        "paginaFinal" => "391"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18632147"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0014256520300060"
                          "estado" => "S300"
                          "issn" => "00142565"
                        ]
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                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of tocilizumab in patients with systemic-onset juvenile idiopathic arthritis&#58; a randomised&#44; double-blind&#44; placebo-controlled&#44; withdrawal phase III trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Yokota"
                            1 => "T&#46; Imagawa"
                            2 => "M&#46; Mori"
                            3 => "T&#46; Miyamae"
                            4 => "Y&#46; Aihara"
                            5 => "S&#46; Takei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(08)60454-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2008"
                        "volumen" => "371"
                        "paginaInicial" => "998"
                        "paginaFinal" => "1006"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18358927"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methotrexate withdrawal at 6 vs 12 months in juvenile idiopathic arthritis in remission&#58; a randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Foell"
                            1 => "N&#46; Wulffraat"
                            2 => "L&#46;R&#46; Wedderburn"
                            3 => "H&#46; Wittkowski"
                            4 => "M&#46; Frosch"
                            5 => "J&#46; Gerss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2010.375"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2010"
                        "volumen" => "303"
                        "paginaInicial" => "1266"
                        "paginaFinal" => "1273"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20371785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of tocilizumab in patients with polyarticular-course juvenile idiopathic arthritis&#58; results from a phase 3&#44; randomised&#44; double-blind withdrawal trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;I&#46; Brunner"
                            1 => "N&#46; Ruperto"
                            2 => "Z&#46; Zuber"
                            3 => "C&#46; Keane"
                            4 => "O&#46; Harari"
                            5 => "A&#46; Kenwright"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2014-205351"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2015"
                        "volumen" => "74"
                        "paginaInicial" => "1110"
                        "paginaFinal" => "1117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24834925"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Biological agents in polyarticular juvenile idiopathic arthritis&#58; a meta-analysis of randomized withdrawal trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Amarilyo"
                            1 => "S&#46; Tarp"
                            2 => "I&#46; Foeldvari"
                            3 => "N&#46; Cohen"
                            4 => "T&#46;D&#46; Pope"
                            5 => "J&#46;M&#46; Woo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.semarthrit.2016.07.001"
                      "Revista" => array:7 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2016"
                        "volumen" => "46"
                        "paginaInicial" => "312"
                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27989499"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0735109714002915"
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                          "issn" => "07351097"
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                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subcutaneous golimumab for children with active polyarticular-course juvenile idiopathic arthritis&#58; results of a multicentre&#44; double-blind&#44; randomised-withdrawal trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;I&#46; Brunner"
                            1 => "N&#46; Ruperto"
                            2 => "N&#46; Tzaribachev"
                            3 => "G&#46; Horneff"
                            4 => "V&#46;G&#46; Chasnyk"
                            5 => "V&#46; Panaviene"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2016-210456"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2018"
                        "volumen" => "77"
                        "paginaInicial" => "21"
                        "paginaFinal" => "29"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28507219"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "When and how to stop etanercept after successful treatment of patients with juvenile idiopathic arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;H&#46; Prince"
                            1 => "M&#46; Twilt"
                            2 => "S&#46;C&#46; Simon"
                            3 => "M&#46;A&#46; van Rossum"
                            4 => "W&#46; Armbrust"
                            5 => "E&#46;P&#46; Hoppenreijs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2008.101030"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2009"
                        "volumen" => "68"
                        "paginaInicial" => "1228"
                        "paginaFinal" => "1229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19525408"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Artificial intelligence to support clinical decision-making processes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Garcia-Vidal"
                            1 => "G&#46; Sanjuan"
                            2 => "P&#46; Puerta-Alcalde"
                            3 => "E&#46; Moreno-Garc&#237;a"
                            4 => "A&#46; Soriano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ebiom.2019.07.019"
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                        "tituloSerie" => "EBioMedicine"
                        "fecha" => "2019"
                        "volumen" => "46"
                        "paginaInicial" => "27"
                        "paginaFinal" => "29"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31303500"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0230"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical remission in juvenile idiopathic arthritis after termination of etanercept"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Postepski"
                            1 => "K&#46; Kobusinska"
                            2 => "E&#46; Olesinska"
                            3 => "V&#46; Osinska"
                            4 => "V&#46; Opoka-Winiarska"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00296-012-2468-3"
                      "Revista" => array:7 [
                        "tituloSerie" => "Rheumatol Int"
                        "fecha" => "2013"
                        "volumen" => "33"
                        "paginaInicial" => "2657"
                        "paginaFinal" => "2660"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22821261"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0085253820307985"
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                          "issn" => "00852538"
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Original Article
What drives the decision to optimise biological treatment in children and youngsters with juvenile idiopathic arthritis? A discrete-choice experiment
Modelo de elección discreta para entender la decisión de optimizar los biológicos en la artritis idiopática juvenil
Sara Muriasa,
Autor para correspondencia
sarapepo@yahoo.es

Corresponding author.
, Alina Boteanub, Inmaculada Calvoc, Esmeralda Nuñezd, Beatriz Bravoe, Sagrario Bustabadf, Marisol Camachog, Daniel Clementeh, Jenaro Grañai, Jaime de Inocencioj, Lucía Lacruzc, Pablo Mesa-del-Castillok, Juan Carlos Nieto-Gonzálezl, María del Carmen Pinedom, Estefanía Quesadan, Carmen Vargaso, Jordi Antónp
a Hospital Universitario La Paz, Madrid, Spain
b Hospital Universitario Ramón y Cajal, Madrid, Spain
c Hospital Universitario y Politécnico La Fe, Valencia, Spain
d Hospital Regional de Málaga, Málaga, Spain
e Hospital Universitario Virgen de las Nieves, Granada, Spain
f Hospital Universitario de Canarias, La Laguna, Spain
g Hospital Universitario Virgen del Rocío, Sevilla, Spain
h Hospital Universitario Infantil Niño Jesús, Madrid, Spain
i Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
j Hospital Universitario 12 de Octubre, Madrid, Spain
k Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
l Hospital General Universitario Gregorio Marañón, Madrid, Spain
m Hospital de Cruces, Baracaldo, Spain
n Hospital Universitario Vall d’Hebron, Barcelona, Spain
o Hospital Universitario Virgen Macarena, Sevilla, Spain
p Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">During the last decades&#44; the treatment and prognosis of patients with juvenile idiopathic arthritis &#40;JIA&#41; have changed dramatically&#46; The introduction of biologic agents coupled by the implementation of agile strategies for monitoring and taking decisions are behind the success&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Biological dose reduction &#8211; also called tapering&#44; de-escalation&#44; adjustment&#44; optimisation&#44; or spacing &#8211; is a widespread practice among paediatric rheumatologists&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> However&#44; the evidence on the maintenance of remission or long-term effects after tapering biologics in JIA is scarce&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> In addition&#44; this decision&#44; taken in clinical practice&#44; is subject to large variability&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Previous experiences on how to taper biological therapies in adults&#44; such as the one carried out by the Spanish Society of Rheumatology &#40;SER&#41; with the REDOSER consensus&#44; have identified patient but not drug-related attributes leading to appropriate tapering&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> The main concern of tapering is relapse&#44; which is not negligible&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> Some of the factors that may play a role in maintaining remission after dose reduction include length of remission&#44; or the absence of subclinical disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3&#44;6&#8211;8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The problems of the paediatric rheumatic population treated with biologics are different from the adult rheumatic population in terms of dosage&#44; efficacy&#44; or the time remaining on the medication&#44; for instance&#46; How to make a dose adjustment does not raise serious questions of evidence&#44; but rather of pharmacokinetics and presentation&#44; which could be extrapolated from adults&#46; However&#44; two more specific problems do arise&#46; On the one hand the reasons&#8212;and fears or reticence&#8212;for which a paediatrician would initiate dose reduction&#44; and on the other&#44; whom should be reduced&#44; taking into account prognostic factors&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Discrete-choice experiments&#44; or conjoint analysis&#44; are a methodology employed in health economics to quantify preferences for medicines and services but can also be used to understand patient preferences for health states&#44; willingness to accept therapeutic risks&#44; and decision making&#44; and can also be used to understand clinical decision making&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> These methods have been previously used in Rheumatology&#44; among others&#44; to comprehend patient preferences<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> and to understand the decision to escalate care in rheumatoid arthritis&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> and so our team thought it could be an adequate methodology to disentangle the decision to taper down biologics in JIA&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this initiative was thus to identify factors involved in the decision to taper disease modifying drugs &#40;DMARD&#41;&#44; being these biological or not&#44; in children and youngsters with JIA&#44; and to quantify their value in the clinical decision-making&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">This is a mixed-methods study&#46; The methodological approach was carried out in different and successive phases&#58; &#40;1&#41; creation of an expert panel that underwent nominal group techniques to elaborate the conceptual model of the dose reduction process&#44; and to start defining factors involved in this process&#59; &#40;2&#41; ratification and addition of factors or levels of factors by a broader group&#59; and &#40;3&#41; discrete-choice experiment to calculate the utility and weights that physicians assign to the factors involved in reducing or not the dose of DMARDs &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Expert&#39;s selection and nominal group</span><p id="par0040" class="elsevierStylePara elsevierViewall">A scientific committee was established with a national representative panel of specialists with proven expertise in JIA management&#46; The selection of experts &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41; was based on their membership of the scientific committee of the Spanish Society of Paediatric Rheumatology &#40;SERPE&#41; and for being heads of the paediatric rheumatology units of university hospitals of recognised prestige and experience&#46; In a face to face meeting with methodologists&#44; nominal group techniques were used to define the process of dose reduction&#44; or interval spacing&#44; in children with JIA in treatment with biologics and their decision nodes&#46; Nominal group techniques imply preparing the concept &#40;in this case&#44; the process of adjusting biologics&#41; before the meeting&#44; having time to think in silence during the meeting&#44; writing down thoughts&#44; and then sharing them out loud&#46; A methodologist expert in this technique made sure that everybody had a chance to present their thoughts and to express their opinions about the others&#8217;&#46; The meeting was organised in two parts&#44; one to understand the process of drug adjustment&#44; and the second to detail what things would change the mind of the expert when adjusting&#46; Brainstorm dynamics were used to elicit factors that could determine dose adjustment at each decision node&#46; The methodologist encouraged discussions&#44; item by item&#44; to make sure the experts had experienced a case&#44; or could think of one&#44; in which a specific patient or drug factor changed their mind of adjusting the dose or not&#46; In addition&#44; potential levels or categories for each factor were started to be defined &#40;e&#46;g&#46;&#44; if age were a factor&#44; the levels could be &#8220;2 years of age or under&#8221; and &#8220;over 2 years&#8221;&#41;&#46; This methodology does not require recording or transcription of discourse&#46; The process map and all items were presented in real time during the meeting in whiteboards and in mind maps to be cross-checked with the experts and notes were taken&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ratification by a broader group</span><p id="par0045" class="elsevierStylePara elsevierViewall">After the first meeting&#44; the map&#44; nodes&#44; and factors were explained to a broader group of &#8776;50 paediatric rheumatologists during a national meeting of the paediatric rheumatology group&#44; at which the previous factors or attributes were ratified&#44; more factors were collected&#44; these were better defined&#44; and levels of the factors further specified&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In both meetings all decisions to include or not to include were taken by unanimity&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discrete-choice experiment &#40;DCE&#41;</span><p id="par0055" class="elsevierStylePara elsevierViewall">This methodology allows to understand the factors that influence the physician&#39;s preferences at the time of reducing or spacing the doses&#46; DCE consists of a survey with several screens presenting two hypothetical clinical scenarios in which the cases are defined each by two alternatives &#40;defined by the factors elicited in previous phases&#41; with varying attribute levels &#40;the categories of factors previously defined&#41;&#46; An example of these scenarios is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; At each pair of scenarios respondents had to decide in which case&#44; or both or none&#44; they would take the decision&#46; Three DCE surveys were created using the 1000Minds&#174; software&#46; Each of the surveys were defined by a decision node &#40;wait&#44; reduce&#47;space&#44; adjust biologic&#41;&#46; The items of the surveys&#44; i&#46;e&#46;&#44; the pairs of scenarios&#44; were created automatically by the programme after feeding it with all the factors and their corresponding levels&#46; Impossible scenarios were deleted with the help of an expert &#40;SM&#41;&#46; The surveys were then sent to the panel of 17 experts&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">A conjoint analysis was used&#46; This statistical technique makes possible to determine which combination of a limited number of attributes has the highest value in a decision<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12&#44;13</span></a>&#46; The result of each selection of hypothetical scenarios is recorded as a rating contingent attached to attributes-levels in the scenarios presented&#44; and an order from the most valued to the least valued &#40;contingent ranking&#41;&#46; The statistics&#44; automatically calculated by the software used &#40;1000Minds&#174;&#41;&#44; were the partial-value functions&#8212;i&#46;e&#46;&#44; the utility that physicians assign to the levels of each attribute&#8212;and the weights of relative importance&#8212;i&#46;e&#46;&#44; which attributes exert a considerable influence on choice&#46; With these values&#44; it is possible to define rankings&#44; i&#46;e&#46;&#44; a value-ordered list of the factors that influence decisions&#44; and weights&#44; i&#46;e&#46;&#44; a measure of the magnitude of the influence&#46; Rankings and weights are both valid ways to present the results&#44; although they are not exchangeable&#59; however&#44; one can easily understand that between two magnitudes of influence&#44; the largest will rank higher&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The panel was composed by 6 men and 11 women&#44; with ages between 32 and 65&#44; being 8 paediatricians&#44; 8 rheumatologists who attended adults and children&#44; and 1 who had both specialities and attended only children currently&#46; All were actively practicing in university hospitals and had access to transition policies and procedures&#46; As part of the criteria&#44; they were all experts in the boards of rheumatology and&#47;or paediatrics associations and had a minimum 5-year experience with biologics&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Process map and decision nodes</span><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows the dose modification process map as discussed in the expert group with the three decision nodes identified&#46; Experts agreed that the entire process begins when a patient arrives at &#8220;remission with treatment&#8221; for at least 6 months&#44; a situation which is well defined by the Wallace criteria &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The first node implies postponing the decision &#40;for an undetermined time&#41; or not&#59; the second decision node would be to modify the dose&#47;interval or not&#59; and the third decision node would be how to modify therapy&#46; A fourth decision was identified in the longer term&#44; when a patient achieves 12 months of remission with optimised treatment&#44; but it was agreed by the panel that this decision was far too complex for this initiative given that there are many modification options available&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Factors determining decisions</span><p id="par0080" class="elsevierStylePara elsevierViewall">In decision node 1 &#40;&#8220;Postpone decision to optimise&#8221;&#41;&#44; and after the two rounds of consultation &#40;small and broader group of experts&#41;&#44; the following factors were identified&#58; systemic or polyarticular predominance&#44; macrophage activation syndrome &#40;MAS&#41; in the past&#44; requirement of two or more treatments to be controlled or previous relapse while lowering the dose&#44; time needed to achieve remission&#44; subclinical inflammation &#40;laboratory or imaging&#41;&#44; involvement of joints difficult to control&#44; tenosynovitis&#44; uveitis&#44; early debut &#40;below the age of four&#41;&#44; and axial involvement&#46; Experts agreed in that these factors did not apply equally to all types of JIA &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The panel of experts established in the first meeting&#44; by consensus&#44; that the results should apply to the different JIA subtypes&#44; grouped for this exercise purposes into&#58; &#8220;systemic&#8221;&#44; &#8220;polyarticular RF&#43;&#8221;&#44; &#8220;oligoarticular and polyarticular RF negative&#8221;&#44; &#8220;arthritis-related enthesitis&#8221; and &#8220;psoriatic arthritis&#8221;&#46; This information was used to prepare the scenarios and delete the impossible ones&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In the second decision node &#40;&#8220;maintain or modify&#8221;&#41; the factors affecting the decision are not so clearly related to patient attributes but to the drug&#44; e&#46;g&#46;&#44; whether the drug is given in monotherapy or has produced immunogenicity&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the third node &#40;&#8220;how&#8221;&#41;&#44; the experts identified the factors affecting the choice of drug to reduce&#44; biologic or non-biologic&#46; This node occurs immediately after the second node&#44; or simultaneously&#46; The factors affecting this decision that were elicited from the discussions were immunogenicity&#44; adherence&#44; and MTX tolerance&#46; Further structure for the &#8220;how to&#8221; decision is presented in a supplementary file&#44; as it was decided not to include given its complexity&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">At the second meeting&#44; the broader group ratified the previous attributes&#44; added a few and defined each attribute and the levels of each factor &#40;final list used in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results from conjoint analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the criterion ranking of the factors involved in the first decision node&#46; To interpret it&#44; the greater the ranking &#40;1&#8211;14&#41;&#44; the less difficulty or doubt to make the decision&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The participants mentioned that the presence of uveitis did not clarify the scenario and that they would have needed to know more about the specific case&#44; such as whether the episode occurred while on treatment&#44; or treatment required to control uveitis &#40;topical&#44; systemic&#44; etc&#46;&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In node 2 &#40;&#8220;to modify or not&#8221;&#41; the two attributes investigated showed a very similar weight &#40;in this case the ranking had less meaning as there were only two attributes&#41;&#44; although the presence of antidrug antibodies made the choice of modifying simpler &#40;weight 6&#41; than if the patient is with more than one drug &#40;combined therapy&#41; for the control of the disease &#40;weight 4&#41;&#46; It was mentioned that it may depend on the biologic agent used&#44; as not all have the same antibody profile&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In node 3 &#40;&#8220;which drug regimen to modify and how&#8221;&#41;&#44; the same situation occurred&#44; the attributes had a similar weight&#44; although the presence of previous toxicity with MTX made the choice simpler &#40;weight 6&#41; than low adherence &#40;weight 4&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">An analysis of attributes by specialty showed no differences or patterns between the preferences of paediatricians &#40;who practice rheumatology&#41; and rheumatologists &#40;who attend children&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">Results show that&#44; for experts in the use of biologics in JIA&#44; the decision is clear when the patient has had a MAS&#44; or systemic involvement&#44; or subclinical inflammation&#44; either analytical or by image&#44; even if at present the patient has been on remission for the last 6 months&#46; The preferred decision was&#44; in all these cases&#44; to postpone or to avoid optimisation&#46; Interestingly enough&#44; other aspects identified by experts as modifying their decisions were not really influencing it&#44; especially the involvement of joints difficult to control or age at debut&#46; Other aspects had different effect when confronted to experts as part of hypothetical scenarios&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The vast majority of randomised controlled trials of biological therapies in children have a phase in which withdrawal is implemented once remission is achieved&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">7&#44;15&#8211;20</span></a> This reflects common practice in paediatric rheumatology&#44; where medications are discontinued as soon as possible to avoid long-term complications&#46; This has led to an &#8220;art of optimisation&#8221;&#44; with each paediatric rheumatologist taking different decisions or using different factors to support them&#46; While variability is not per se unwanted&#44; when it exists&#44; it should be based on solid grounds of proven efficacious and safe options&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> As Halyabar et al&#46; nicely summarised in their systematic review&#44; the disease is heterogeneous&#44; the definition of inactivity is heterogeneous&#44; disease management is heterogeneous&#44; consequently&#44; &#8220;decisions often revolve around perceptions of the relative risks of continuing versus stopping treatment&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Several studies&#44; many small&#44; most retrospective&#44; have studied outcomes of children with JIA who discontinued therapies after achieving inactive disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#44;5&#8211;7</span></a> Evidence shows that flares are common after discontinuation&#44; ranging from 30 to 100&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> This is one of the reasons why optimisation rather than withdrawal is attempted&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2&#44;7&#44;21</span></a> However&#44; optimisation is not as well studied as withdrawal&#44; neither are factors influencing outcome&#44; and paediatric rheumatologists do not have a guidance on how to actually do it with guarantees in JIA&#44; as it is the case with adults&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">We are confident in that the results reflect actual mental processes based on experience&#46; The discrete-choice method interrogates highly experienced individuals and confront them with a set of hypothetical scenarios with several levels of two or more attributes and ask them to choose the one they prefer &#40;choice experiment&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a> This method identifies preferences and factors influencing decisions more efficiently than real data&#44; at least with feasible numbers and wealth of factors&#46; This methodology also has some drawbacks&#46; Respondents use simplification strategies when facing many options&#44; when the reality is that the situation in front of a patient is far more complex than two variables at a time&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a> Experts would have wanted more information and more options&#44; as shown by their comments on uveitis&#44; for example&#46; Also&#44; the experts responding the survey could have used simplification strategies&#44; for instance&#44; always choosing conservative options&#44; a limitation we cannot rule out with this design&#46; However&#44; our intention was to identify the factors that most plausibly influence the decision and to rank them&#44; rather than obtaining a composite weighted score or similar output&#46; We cannot discard that&#44; in the future&#44; the understanding of decisions could be better carried out with some method using artificial intelligence&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> Currently&#44; this is the most adequate methodology we could think of to help guiding decisions of non-experts&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In our initiative&#44; we have attempted to study the decision process by first having experts discussing on their experiences and studies&#44; then by testing the factors they think they use in their decisions to weight the importance in the decision&#46; This experiment found no sociodemographic factors determining decisions&#44; while in many studies these are the first factors to study&#44;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4&#44;6&#44;7&#44;23</span></a> and identified other factors that should now be tested or used for studies in the long term&#46; The discussions were extremely rich and factors that appeared initially as determinants&#44; then faded away when seen on light of other factors&#44; e&#46;g&#46;&#44; comorbidity&#44; like psoriasis or inflammatory bowel disease were put forward as factors in a first step&#44; but when the classification into four groups was established as well as the starting point of remission&#44; they disappeared as relevant for the decision to taper&#46; It could be argued that the number of experts was low and that the survey should have had many more respondents&#46; Given the complexity of the clinical decision making in this specific situation&#44; our resolution was to weight expertise more than sample size&#44; as the final aim was to use these results to inform recommendations on the adjustment of biologics in JIA&#46; Also&#44; not including experts from other countries was determined to facilitate discussions in a common language in which all were fluid&#44; as our experience is that Spanish experts are excellent clinicians but do not participate comfortably in international panels due to language constrictions&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The next steps will be to study the appropriateness of each optimisation strategy &#40;continuation of decision node 3&#41;&#44; but this will require a different approach&#46; Our aim for a second step is to review the literature on available options on how to taper biologics&#44; and to run a national survey&#44; targeted at paediatric rheumatologists&#44; on tapering practices&#46; Ideally&#44; we should design large observational studies to compare the different options&#44; but this is not easy in the context of rare diseases&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In summary&#44; the decision to optimise the dose of biological therapy in children and youngsters can be granulated into several nodes&#44; and the factors&#44; both patient and therapy-related&#44; leading to the decision can be detailed&#46; These decisions taken by experts may be transported to practice&#44; study designs&#44; and guidelines&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Data sharing statement</span><p id="par0160" class="elsevierStylePara elsevierViewall">Data are available upon request&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Authors&#8217; contributions</span><p id="par0165" class="elsevierStylePara elsevierViewall">SM designed&#44; coordinated&#44; analysed and wrote the manuscript&#59; AB&#44; IC&#44; EN&#44; BB&#44; SB&#44; MC&#44; DC&#44; JG&#44; JdI&#44; LLC&#44; PMC&#44; JCNG&#44; MCP&#44; EQ&#44; CV&#44; and JA contributed to the discussions&#44; answered the discrete choice surveys and helped in the preparation of the manuscript&#46; All authors revised the last version&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Ethical approval and patient and public involvement</span><p id="par0170" class="elsevierStylePara elsevierViewall">The nature of the study&#44; theoretical and with no inclusion of real patients&#8217; data&#44; does not make it necessary to undergo ethical review according to local regulations&#46; For its technical difficulty and given that all decisions are physician based&#44; patients or public were not involved in the project&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">The study was funded by the Spanish Society of Paediatric Rheumatology &#40;<span class="elsevierStyleGrantSponsor" id="gs1">SERPE</span>&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">S&#46;M reports grants from Spanish Paediatric Rheumatology Society&#59; A&#46;B has nothing to disclose&#59; I&#46;C&#46;P has nothing to disclose&#59; E&#46;N&#46;C reports grants from Spanish Paediatric Rheumatology Society&#59; B&#46;B reports grants from SERPE&#59; S&#46;B has nothing to disclose&#59; M&#46;C&#46;L reports grants from SERPE&#59; D&#46;C&#46; reports grants from Spanish Paediatric Rheumatology Society&#44; from null&#44; during the conduct of the study&#59; personal fees from Lectures for Abbvie&#44; Roche and Novartis&#44; outside the submitted work&#59; B&#46;B reports grants from SERPE&#59; J de I&#46; reports grants from Spanish Paediatric Rheumatology Society&#59; L&#46;L&#46; has nothing to disclose&#59; P&#46;M&#46;D&#46;C&#46; has nothing to disclose&#59; J&#46;C&#46;N&#46;G&#46; has nothing to disclose&#59; MC&#46;P&#46; reports grants from SERPE&#59; E&#46;Q-M has nothing to disclose&#59; C&#46;V&#46; reports other from Pfizer&#44; Abbie&#44; Roche&#44; Novartis&#44; UCB&#44; SERPE&#44; SER&#44; FISEVI&#59; J&#46;A&#46; reports grants from Spanish Paediatric Rheumatology Society&#46;</p></span></span>"
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            0 => "Juvenile idiopathic arthritis"
            1 => "Biologic therapies"
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            1 => "Terapias biol&#243;gicas"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyse factors involved in the decision to optimise biologics in juvenile idiopathic arthritis&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A &#8220;discrete-choice&#8221; methodology was used&#46; In a nominal group meeting&#44; factors which may influence physicians&#8217; decisions to optimise biological dose were identified&#44; together with decision nodes&#46; 1000Minds&#174; was used to create multiple fictitious clinical scenarios based on the factors identified&#44; and to deploy surveys that were sent to a panel of experts&#46; These experts decided for each item which of two clinical scenarios prompted them to optimise the dose of biologic&#46; A conjoint analysis was carried out&#44; and the partial-value functions and the weights of relative importance calculated&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In the nominal group&#44; three decision nodes were identified&#58; &#40;1&#41; time to decide&#59; &#40;2&#41; to maintain&#47;reduce or prolong interval&#59; &#40;3&#41; what drug to reduce&#46; The factors elicited were different for each node and included patient and drug attributes&#46; The presence of macrophage activation syndrome &#40;MAS&#41;&#44; systemic involvement&#44; or subclinical inflammation made the decision easier &#40;highest weights&#41;&#46; The presence of joints of difficult control and year of debut influenced the decision in some but not all&#44; and in different directions&#46; Immunogenicity&#44; adherence&#44; and concomitant treatments were also aspects taken into account&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The decision to optimise the dose of biological therapy in children and youngster can be divided into several nodes&#44; and the factors&#44; both patient and therapy-related&#44; leading to the decision can be detailed&#46; These decisions taken by experts may be transported to practice&#44; study designs&#44; and guidelines&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar los factores que intervienen en la decisi&#243;n de optimizar el biol&#243;gico en la artritis idiop&#225;tica juvenil&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se utiliz&#243; la metodolog&#237;a de &#171;elecci&#243;n discreta&#187;&#46; Mediante grupo nominal se identificaron factores potencialmente influyentes en la decisi&#243;n de optimizar la dosis de biol&#243;gico y los nodos de decisi&#243;n&#46; Con 1000Minds&#174; se crearon escenarios cl&#237;nicos ficticios basados en los factores identificados que se mostraron en encuestas a un panel de expertos&#46; Cada &#237;tem de las encuestas mostraba 2 escenarios cl&#237;nicos y los expertos eleg&#237;an el que les llevar&#237;a a optimizar el biol&#243;gico&#46; Se realiz&#243; un an&#225;lisis conjunto&#44; calcul&#225;ndose las funciones de valor parcial y los pesos de importancia relativa&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se identificaron 3 nodos de decisi&#243;n&#58; 1&#41; dilatar decisi&#243;n o no&#59; 2&#41; mantener&#47;reducir o prolongar el intervalo&#59; y 3&#41; qu&#233; f&#225;rmaco reducir&#46; Los factores identificados var&#237;an por nodo e incluyen atributos del paciente y del f&#225;rmaco&#46; La presencia del s&#237;ndrome de activaci&#243;n macrof&#225;gica&#44; la afectaci&#243;n sist&#233;mica o la inflamaci&#243;n subcl&#237;nica facilitaron la decisi&#243;n &#40;pesos m&#225;s altos&#41;&#46; La presencia de articulaciones de dif&#237;cil control y el a&#241;o de inicio influyeron en la decisi&#243;n en algunos casos&#44; pero no en todos&#44; y en diferentes direcciones&#46; La inmunogenicidad&#44; la adherencia y los tratamientos concomitantes tambi&#233;n fueron aspectos decisivos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La decisi&#243;n de optimizar la dosis de biol&#243;gico en artritis idiop&#225;tica juvenil se divide en varios nodos y se pueden detallar factores&#44; tanto del paciente como del tratamiento&#44; que determinan la decisi&#243;n&#46; Estas decisiones de experto pueden transportarse a la pr&#225;ctica&#44; la investigaci&#243;n y las recomendaciones&#46;</p></span>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Based on the Wallace criteria&#44; a child or youngster with JIA is in remission if&#58;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- No arthritis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- No fever&#44; no rash&#44; no serositis&#44; no lymph nodes or myalgias attributable to the disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- No active uveitis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Normal acute phase reactants &#40;PCR and VSG&#41;&#44; or elevated by causes not attributable to JIA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Morning stiffness<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- No activity by any scale used by the professional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#46; Active disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46; Inactive disease &#40;Wallace criteria are met&#41;&#46; It can be with or without treatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46; Disease in remission on treatment<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#8211; Inactivity persists<span class="elsevierStyleHsp" style=""></span>&#62;&#61;<span class="elsevierStyleHsp" style=""></span>6 months&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46; Disease in remission off treatment &#8211; Inactivity persists<span class="elsevierStyleHsp" style=""></span>&#62;&#61;<span class="elsevierStyleHsp" style=""></span>12 months after treatment discontinuation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">For remission with treatment in psoriatic arthritis&#44; the skin must have no lesions&#46;</p>"
            ]
          ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Definition of &#8220;remission on and off treatment&#8221;&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Attributes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Classification</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Systemic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Polyarticular RF&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Oligo-polyarticular RF&#8722; or psoriatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Enthesitic-related arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systemic predominance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polyarticular predominance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Has required 2 or more treatments or has previously relapsed while lowering the dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time to remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subclinical inflammation &#40;laboratory&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subclinical inflammation &#40;imaging&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Difficult to control joints&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tenosynovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early debut &#40;age<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Axial involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Factors that may lead to postponing the decision to modify dose&#46; As elicited from experts discussions of experiences&#44; by type of JIA&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Node&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Factors&#47;attributes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Levels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systemic involvement<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&#46; joints&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;&#61;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rheumatoid factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAS<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Has presented it in the past&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Has not presented it&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&#46; treatments needed to reach remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st DMARD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 DMARD then 1st biologic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 or more biologics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time to remission<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;&#61;1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subclinical inflammation &#40;laboratory&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subclinical inflammation &#40;imaging&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal ultrasound&#44; including Power-Doppler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Power-Doppler signal in joint or tendon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Joints difficult to control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Temporomandibular joint&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carpal synovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tarsal-sub astragalin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hips&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carpal tenosynovitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uveitis<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;2 episodes&#44; without complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;&#61;2 episodes&#44; without complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">With complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early debut &#40;&#60;4 years old&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset &#60;4&#47;onset &#62;&#61;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Axial involvement<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Axial involvement&#47;no axial involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Monotherapy<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Monotherapy&#47;combined therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Immunogenicity<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">h</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unknown drug levels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Undetectable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anti-drug antibodies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3rd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adherence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor&#47;good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methotrexate intolerance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                      "titulo" => "Attitudes and approaches for withdrawing drugs for children with clinically inactive nonsystemic JIA&#58; a survey of the childhood arthritis and rheumatology research alliance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                      "titulo" => "Clinical trial of etanercept tapering in juvenile idiopathic arthritis during remission"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46; Cai"
                            1 => "X&#46; Liu"
                            2 => "W&#46; Zhang"
                            3 => "J&#46; Xu"
                            4 => "L&#46; Cao"
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                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatol Int"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Defining juvenile idiopathic arthritis remission and optimum time for disease-modifying anti-rheumatic drug withdrawal&#58; why we need a consensus"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                            1 => "K&#46; Armon"
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                    0 => array:2 [
                      "doi" => "10.2165/11595980-000000000-00000"
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                        "tituloSerie" => "Paediatr Drugs"
                        "fecha" => "2012"
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                        "paginaInicial" => "7"
                        "paginaFinal" => "12"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22149548"
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              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spanish Rheumatology Society and Hospital Pharmacy Society Consensus on recommendations for biologics optimization in patients with rheumatoid arthritis&#44; ankylosing spondylitis and psoriatic arthritis"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Gonzalez-Alvaro"
                            1 => "C&#46; Martinez-Fernandez"
                            2 => "B&#46; Dorantes-Calderon"
                            3 => "R&#46; Garcia-Vicuna"
                            4 => "B&#46; Hernandez-Cruz"
                            5 => "A&#46; Herrero-Ambrosio"
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                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/keu461"
                      "Revista" => array:7 [
                        "tituloSerie" => "Rheumatology &#40;Oxford&#41;"
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                        "volumen" => "54"
                        "paginaInicial" => "1200"
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                        "link" => array:1 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment withdrawal following remission in juvenile idiopathic arthritis&#58; a systematic review of the literature"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "O&#46; Halyabar"
                            1 => "J&#46; Mehta"
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                            4 => "D&#46;B&#46; Horton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Paediatr Drugs"
                        "fecha" => "2019"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical outcomes after withdrawal of anti-tumor necrosis factor alpha therapy in patients with juvenile idiopathic arthritis&#58; a twelve-year experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Baszis"
                            1 => "J&#46; Garbutt"
                            2 => "D&#46; Toib"
                            3 => "J&#46; Mao"
                            4 => "A&#46; King"
                            5 => "A&#46; White"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.30502"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2011"
                        "volumen" => "63"
                        "paginaInicial" => "3163"
                        "paginaFinal" => "3168"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21702011"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of medication withdrawal method on flare-free survival in patients with juvenile idiopathic arthritis on combination therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;Y&#46; Chang"
                            1 => "R&#46;M&#46; Meyer"
                            2 => "A&#46;O&#46; Reiff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/acr.22477"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
                        "fecha" => "2015"
                        "volumen" => "67"
                        "paginaInicial" => "658"
                        "paginaFinal" => "666"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25220674"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Flares after withdrawal of biologic therapies in juvenile idiopathic arthritis&#58; clinical and laboratory correlates of remission duration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Simonini"
                            1 => "G&#46; Ferrara"
                            2 => "I&#46; Pontikaki"
                            3 => "E&#46; Scoccimarro"
                            4 => "T&#46; Giani"
                            5 => "A&#46; Taddio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Conjoint analysis applications in health &#8211; a checklist&#58; a report of the ISPOR Good Research Practices for Conjoint Analysis Task Force"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Bridges"
                            1 => "A&#46;B&#46; Hauber"
                            2 => "D&#46; Marshall"
                            3 => "A&#46; Lloyd"
                            4 => "L&#46;A&#46; Prosser"
                            5 => "D&#46;A&#46; Regier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Value Health"
                        "fecha" => "2011"
                        "volumen" => "14"
                        "paginaInicial" => "403"
                        "paginaFinal" => "413"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient preferences regarding rheumatoid arthritis therapies&#58; a conjoint analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;M&#46; Louder"
                            1 => "A&#46; Singh"
                            2 => "K&#46; Saverno"
                            3 => "J&#46;C&#46; Cappelleri"
                            4 => "A&#46;J&#46; Aten"
                            5 => "A&#46;S&#46; Koenig"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Health Drug Benefits"
                        "fecha" => "2016"
                        "volumen" => "9"
                        "paginaInicial" => "84"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27668050"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors that influence rheumatologists&#8217; decisions to escalate care in rheumatoid arthritis&#58; results from a choice-based conjoint analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46; Kievit"
                            1 => "L&#46; van Hulst"
                            2 => "P&#46; van Riel"
                            3 => "L&#46; Fraenkel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/acr.20123"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
                        "fecha" => "2010"
                        "volumen" => "62"
                        "paginaInicial" => "842"
                        "paginaFinal" => "847"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20535795"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What should be the cut point for classification criteria of studies in gout&#63; A conjoint analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Fransen"
                            1 => "W&#46; Kievit"
                            2 => "T&#46; Neogi"
                            3 => "R&#46; Schumacher"
                            4 => "T&#46; Jansen"
                            5 => "N&#46; Dalbeth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
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                        "volumen" => "68"
                        "paginaInicial" => "1731"
                        "paginaFinal" => "1735"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pros and cons of conjoint analysis of discrete choice experiments to define classification and response criteria in rheumatology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;J&#46; Taylor"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/BOR.0000000000000259"
                      "Revista" => array:7 [
                        "tituloSerie" => "Curr Opin Rheumatol"
                        "fecha" => "2016"
                        "volumen" => "28"
                        "paginaInicial" => "117"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26780423"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109721049688"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Childhood Arthritis and Rheumatology Research Alliance&#59; Pediatric Rheumatology International Trials Organization&#59; Pediatric Rheumatology Collaborative Study Group"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;A&#46; Wallace"
                            1 => "N&#46; Ruperto"
                            2 => "E&#46; Giannini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2004"
                        "volumen" => "31"
                        "paginaInicial" => "2290"
                        "paginaFinal" => "2294"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0190"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Abatacept in children with juvenile idiopathic arthritis&#58; a randomised&#44; double-blind&#44; placebo-controlled withdrawal trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Ruperto"
                            1 => "D&#46;J&#46; Lovell"
                            2 => "P&#46; Quartier"
                            3 => "E&#46; Paz"
                            4 => "N&#46; Rubio-Perez"
                            5 => "C&#46;A&#46; Silva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(08)60998-8"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2008"
                        "volumen" => "372"
                        "paginaInicial" => "383"
                        "paginaFinal" => "391"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18632147"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0014256520300060"
                          "estado" => "S300"
                          "issn" => "00142565"
                        ]
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                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of tocilizumab in patients with systemic-onset juvenile idiopathic arthritis&#58; a randomised&#44; double-blind&#44; placebo-controlled&#44; withdrawal phase III trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            0 => "S&#46; Yokota"
                            1 => "T&#46; Imagawa"
                            2 => "M&#46; Mori"
                            3 => "T&#46; Miyamae"
                            4 => "Y&#46; Aihara"
                            5 => "S&#46; Takei"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(08)60454-7"
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                        "tituloSerie" => "Lancet"
                        "fecha" => "2008"
                        "volumen" => "371"
                        "paginaInicial" => "998"
                        "paginaFinal" => "1006"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18358927"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0200"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methotrexate withdrawal at 6 vs 12 months in juvenile idiopathic arthritis in remission&#58; a randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Foell"
                            1 => "N&#46; Wulffraat"
                            2 => "L&#46;R&#46; Wedderburn"
                            3 => "H&#46; Wittkowski"
                            4 => "M&#46; Frosch"
                            5 => "J&#46; Gerss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2010.375"
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                        "tituloSerie" => "JAMA"
                        "fecha" => "2010"
                        "volumen" => "303"
                        "paginaInicial" => "1266"
                        "paginaFinal" => "1273"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20371785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0205"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of tocilizumab in patients with polyarticular-course juvenile idiopathic arthritis&#58; results from a phase 3&#44; randomised&#44; double-blind withdrawal trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;I&#46; Brunner"
                            1 => "N&#46; Ruperto"
                            2 => "Z&#46; Zuber"
                            3 => "C&#46; Keane"
                            4 => "O&#46; Harari"
                            5 => "A&#46; Kenwright"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2014-205351"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2015"
                        "volumen" => "74"
                        "paginaInicial" => "1110"
                        "paginaFinal" => "1117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24834925"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Biological agents in polyarticular juvenile idiopathic arthritis&#58; a meta-analysis of randomized withdrawal trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "I&#46; Foeldvari"
                            3 => "N&#46; Cohen"
                            4 => "T&#46;D&#46; Pope"
                            5 => "J&#46;M&#46; Woo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.semarthrit.2016.07.001"
                      "Revista" => array:7 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2016"
                        "volumen" => "46"
                        "paginaInicial" => "312"
                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27989499"
                            "web" => "Medline"
                          ]
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                          "pii" => "S0735109714002915"
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                          "issn" => "07351097"
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                  ]
                ]
              ]
            ]
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              "identificador" => "bib0215"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subcutaneous golimumab for children with active polyarticular-course juvenile idiopathic arthritis&#58; results of a multicentre&#44; double-blind&#44; randomised-withdrawal trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;I&#46; Brunner"
                            1 => "N&#46; Ruperto"
                            2 => "N&#46; Tzaribachev"
                            3 => "G&#46; Horneff"
                            4 => "V&#46;G&#46; Chasnyk"
                            5 => "V&#46; Panaviene"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2016-210456"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2018"
                        "volumen" => "77"
                        "paginaInicial" => "21"
                        "paginaFinal" => "29"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28507219"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "When and how to stop etanercept after successful treatment of patients with juvenile idiopathic arthritis"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;H&#46; Prince"
                            1 => "M&#46; Twilt"
                            2 => "S&#46;C&#46; Simon"
                            3 => "M&#46;A&#46; van Rossum"
                            4 => "W&#46; Armbrust"
                            5 => "E&#46;P&#46; Hoppenreijs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2008.101030"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2009"
                        "volumen" => "68"
                        "paginaInicial" => "1228"
                        "paginaFinal" => "1229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19525408"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Artificial intelligence to support clinical decision-making processes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Garcia-Vidal"
                            1 => "G&#46; Sanjuan"
                            2 => "P&#46; Puerta-Alcalde"
                            3 => "E&#46; Moreno-Garc&#237;a"
                            4 => "A&#46; Soriano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ebiom.2019.07.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "EBioMedicine"
                        "fecha" => "2019"
                        "volumen" => "46"
                        "paginaInicial" => "27"
                        "paginaFinal" => "29"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31303500"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical remission in juvenile idiopathic arthritis after termination of etanercept"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Postepski"
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Información del artículo
ISSN: 1699258X
Idioma original: Inglés
DOI:10.1016/j.reuma.2021.12.003
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