TNF and juvenile idiopathic arthritis: Circulating pathogenic-like lymphocytes (CPLs), a subset of circulatory CD4 T effector (Teff) cells that mirror the pro-inflammatory phenotype of synovial CD4 T cells and expressing HLA-DR, were identified in significantly greater numbers in patients with active JIA who were resistant to methotrexate (MTX) and anti-TNF-α therapy (22).