Diagnosis and treatment of enthesitis-related arthritis

Abstract

Juvenile idiopathic arthritis (JIA) is a chronic, inflammatory disease of unknown etiology. The enthesitis-related arthritis (ERA) JIA category describes a clinically heterogeneous group of children including some who have predominately enthesitis, enthesitis and arthritis, juvenile ankylosing spondylitis, or inflammatory bowel disease-associated arthropathy. ERA accounts for 10%–20% of JIA. Common clinical manifestations of ERA include arthritis, enthesitis, and acute anterior uveitis. Axial disease is also common in children with established ERA. Treatment regimens for ERA, many of them based on adults with rheumatoid arthritis and ankylosing spondylitis, include the use of nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, and biologic agents either individually or in combination.

Ентезопатії При Анкілозивному Спондиліті, Що Почався В Дитячому Та Дорослому Віці

“…Malaviya et al [7] ЮАС вообще рассматривают как энтезитассо-циированный артрит, хотя, по данным P.F. Weiss [17], частота энтезитассоциированного варианта болезни не Îðèã³íàëüí³ äîñë³äaeåííÿ / Original Researches превышает 20 % от числа таких больных. Сравнитель-ная оценка энтезопатии при ЮАС и ВАС остается не выполненной.…”

Diagnosis and Treatment of Low Back Pain in the Pediatric Population

“…Approximately 60% are males, 45% are HLA-B27 positive, 69 and most cases present during adolescence. 70 The presence of enthesitis, or tenderness at the sites of tendon, ligament, or joint capsule insertions should raise suspicion of the diagnosis. Axial involvement may be characterized by pain, decreased forward flexion, loss of lumbar lordosis on forward flexion, and tenderness of the sacroiliac joints.…”

“…Biologics including anti-tumor necrosis factor agents such as etanercept and adalimumab can be helpful to improve symptoms and function. 70 DMARDs such as methotrexate and sulfasalazine may be helpful for peripheral arthritis but have not been shown to improve axial disease in adults.…”

Discordant inflammatory changes in the apophyseal and sacroiliac joints: serial observations in enthesitis-related arthritis

“…2 Axial inflammation is a hallmark of ERA and up to 35-48% of children with ERA have clinical or radiographic evidence of sacroiliitis. [3][4][5][6] A subset of children with sacroiliitis will progress to spondylitis as adults, which is characterized by back pain, stiffness and eventual fusion of the vertebra. 3 Early treatment in spondyloarthritis may have a disease-modifying effect and consequently improve outcomes; 7 but, if treatment is inadequate, then outcomes are poor in terms of physical health, pain and physical activity.…”

“…[3][4][5][6] A subset of children with sacroiliitis will progress to spondylitis as adults, which is characterized by back pain, stiffness and eventual fusion of the vertebra. 3 Early treatment in spondyloarthritis may have a disease-modifying effect and consequently improve outcomes; 7 but, if treatment is inadequate, then outcomes are poor in terms of physical health, pain and physical activity. 4 MRI is commonly used in ERA and has traditionally focused on the early detection of inflammation at the SIJs.…”