16041431000119108: Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)

SNOMED CT Concept\Clinical finding (finding)\...

\Finding of limb structure\Disorder of limb (disorder)\Inflammatory disorder of extremity\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Finding of limb structure\Disorder of limb (disorder)\Disorder of upper limb (disorder)\Disorder of right upper extremity (disorder)\Disorder of joint of right shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Finding of limb structure\Disorder of limb (disorder)\Disorder of upper limb (disorder)\Disorder of shoulder region (disorder)\Disorder of joint of shoulder region (disorder)\Disorder of joint of right shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Finding of limb structure\Disorder of limb (disorder)\Disorder of upper limb (disorder)\Disorder of shoulder region (disorder)\Disorder of joint of shoulder region (disorder)\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Finding of limb structure\Finding of upper limb\Disorder of upper limb (disorder)\Disorder of right upper extremity (disorder)\Disorder of joint of right shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Finding of limb structure\Finding of upper limb\Disorder of upper limb (disorder)\Disorder of shoulder region (disorder)\Disorder of joint of shoulder region (disorder)\Disorder of joint of right shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Finding of limb structure\Finding of upper limb\Disorder of upper limb (disorder)\Disorder of shoulder region (disorder)\Disorder of joint of shoulder region (disorder)\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Finding of limb structure\Finding of upper limb\Finding of shoulder region\Inflammation of joint of shoulder region\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Finding of limb structure\Finding of upper limb\Finding of shoulder region\Disorder of shoulder region (disorder)\Disorder of joint of shoulder region (disorder)\Disorder of joint of right shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Finding of limb structure\Finding of upper limb\Finding of shoulder region\Disorder of shoulder region (disorder)\Disorder of joint of shoulder region (disorder)\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)

\Temperature-associated finding\Body temperature finding\Abnormal body temperature\Body temperature above reference range\...

\Febrile disorder (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)

\Fever (finding)\Chronic fever (finding)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)

\Musculoskeletal finding\Joint finding\Arthropathy (disorder)\Disorder of joint of shoulder region (disorder)\Disorder of joint of right shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Joint finding\Arthropathy (disorder)\Disorder of joint of shoulder region (disorder)\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Joint finding\Arthropathy (disorder)\Chronic arthropathy\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Joint finding\Arthropathy (disorder)\Arthritis\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Joint finding\Arthropathy (disorder)\Arthritis\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Joint finding\Inflammation of joint (finding)\Inflammation of joint of shoulder region\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Joint finding\Inflammation of joint (finding)\Arthritis\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Joint finding\Inflammation of joint (finding)\Arthritis\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Disorder of musculoskeletal system\Inflammatory disorder of musculoskeletal system\Arthritis\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Disorder of musculoskeletal system\Inflammatory disorder of musculoskeletal system\Arthritis\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Disorder of musculoskeletal system\Chronic disease of musculoskeletal system\Chronic arthropathy\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Disorder of musculoskeletal system\Disorder of skeletal system\Arthropathy (disorder)\Disorder of joint of shoulder region (disorder)\Disorder of joint of right shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Disorder of musculoskeletal system\Disorder of skeletal system\Arthropathy (disorder)\Disorder of joint of shoulder region (disorder)\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Disorder of musculoskeletal system\Disorder of skeletal system\Arthropathy (disorder)\Chronic arthropathy\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Disorder of musculoskeletal system\Disorder of skeletal system\Arthropathy (disorder)\Arthritis\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Musculoskeletal finding\Disorder of musculoskeletal system\Disorder of skeletal system\Arthropathy (disorder)\Arthritis\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)

\General body state finding\Vital signs finding\Body temperature finding\Abnormal body temperature\Body temperature above reference range\...

\Febrile disorder (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)

\Fever (finding)\Chronic fever (finding)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)

\Disease\Disorder of joint region\Arthropathy (disorder)\Disorder of joint of shoulder region (disorder)\Disorder of joint of right shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of joint region\Arthropathy (disorder)\Disorder of joint of shoulder region (disorder)\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of joint region\Arthropathy (disorder)\Chronic arthropathy\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of joint region\Arthropathy (disorder)\Arthritis\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of joint region\Arthropathy (disorder)\Arthritis\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of joint region\Disorder of shoulder region (disorder)\Disorder of joint of shoulder region (disorder)\Disorder of joint of right shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of joint region\Disorder of shoulder region (disorder)\Disorder of joint of shoulder region (disorder)\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Febrile disorder (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of immune function (disorder)\Chronic disease of immune function (disorder)\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of immune function (disorder)\Autoimmune disease\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of body system\Inflammation of specific body systems\Inflammatory disorder of musculoskeletal system\Arthritis\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of body system\Inflammation of specific body systems\Inflammatory disorder of musculoskeletal system\Arthritis\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of body system\Disorder of musculoskeletal system\Inflammatory disorder of musculoskeletal system\Arthritis\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of body system\Disorder of musculoskeletal system\Inflammatory disorder of musculoskeletal system\Arthritis\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of body system\Disorder of musculoskeletal system\Chronic disease of musculoskeletal system\Chronic arthropathy\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of body system\Disorder of musculoskeletal system\Disorder of skeletal system\Arthropathy (disorder)\Disorder of joint of shoulder region (disorder)\Disorder of joint of right shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of body system\Disorder of musculoskeletal system\Disorder of skeletal system\Arthropathy (disorder)\Disorder of joint of shoulder region (disorder)\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of body system\Disorder of musculoskeletal system\Disorder of skeletal system\Arthropathy (disorder)\Chronic arthropathy\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of body system\Disorder of musculoskeletal system\Disorder of skeletal system\Arthropathy (disorder)\Arthritis\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of body system\Disorder of musculoskeletal system\Disorder of skeletal system\Arthropathy (disorder)\Arthritis\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of limb (disorder)\Inflammatory disorder of extremity\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of limb (disorder)\Disorder of upper limb (disorder)\Disorder of right upper extremity (disorder)\Disorder of joint of right shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of limb (disorder)\Disorder of upper limb (disorder)\Disorder of shoulder region (disorder)\Disorder of joint of shoulder region (disorder)\Disorder of joint of right shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Disorder of limb (disorder)\Disorder of upper limb (disorder)\Disorder of shoulder region (disorder)\Disorder of joint of shoulder region (disorder)\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Inflammatory disorder\Inflammation of specific body structures or tissue\Inflammatory disorder of extremity\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Inflammatory disorder\Inflammation of specific body structures or tissue\Inflammation of specific body systems\Inflammatory disorder of musculoskeletal system\Arthritis\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Inflammatory disorder\Inflammation of specific body structures or tissue\Inflammation of specific body systems\Inflammatory disorder of musculoskeletal system\Arthritis\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Inflammatory disorder\Inflammation of specific body structures or tissue\Inflammation of specific body organs\Arthritis\Arthritis of shoulder region joint\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Inflammatory disorder\Inflammation of specific body structures or tissue\Inflammation of specific body organs\Arthritis\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Inflammatory disorder\Chronic inflammatory disorder\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Systemic disease\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Idiopathic disease\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Chronic disease\Chronic disease of immune function (disorder)\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Chronic disease\Chronic inflammatory disorder\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)
\Disease\Chronic disease\Chronic disease of musculoskeletal system\Chronic arthropathy\Chronic arthritis\Juvenile idiopathic arthritis (disorder)\Systemic onset juvenile chronic arthritis (disorder)\Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)\Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)

Status: current, Sufficiently defined by necessary conditions definition status (core metadata concept). Date: 01-Jun 2024. Module: SNOMED CT core

Descriptions:

Id Description Lang Type Status Case? Module

5354971012 Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder) en Fully specified name Active Entire term case insensitive (core metadata concept) SNOMED CT core

5354973010 Systemic onset juvenile idiopathic arthritis of right shoulder en Synonym (core metadata concept) Active Entire term case insensitive (core metadata concept) SNOMED CT core

5354985019 Systemic onset juvenile idiopathic arthritis of joint of right shoulder region en Synonym (core metadata concept) Active Entire term case insensitive (core metadata concept) SNOMED CT core

Expanded Value Set

Outbound Relationships	Type	Target	Active	Characteristic	Refinability	Group	Values
Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)	Is a	Disorder of joint of right shoulder region (disorder)	true	Inferred relationship	Some
Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)	Clinical course	Chronic	true	Inferred relationship	Some	3
Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)	Interprets	Body temperature (observable entity)	true	Inferred relationship	Some	2
Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)	Has interpretation	Above reference range	true	Inferred relationship	Some	2
Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)	Occurrence	Childhood	true	Inferred relationship	Some	1
Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)	Finding site	Structure of joint of right shoulder region (body structure)	true	Inferred relationship	Some	1
Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)	Associated morphology	Chronic inflammatory morphology (morphologic abnormality)	true	Inferred relationship	Some	1
Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)	Pathological process (attribute)	Autoimmune process	true	Inferred relationship	Some	1
Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)	Is a	Systemic onset juvenile idiopathic arthritis of joint of shoulder region (disorder)	true	Inferred relationship	Some

Inbound Relationships	Type	Active	Source	Characteristic	Refinability	Group
Systemic onset juvenile idiopathic arthritis of joint of bilateral shoulder regions (disorder)	Is a	True	Systemic onset juvenile idiopathic arthritis of joint of right shoulder region (disorder)	Inferred relationship	Some

This concept is not in any reference sets