Early Predictors of Juvenile Sacroiliitis in Enthesitis-related Arthritis

Pagnini, Ilaria; Savelli, Sara; Matucci‐Cerinic, Marco; Fonda, Claudio; Cimaz, Rolando; Simonini, Gabriele

doi:10.3899/jrheum.100090

Cited by 95 publications

(83 citation statements)

References 20 publications

(14 reference statements)

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“…This ratio is similar to recent studies in adult spondyloarthropathy (SpA) where the male: female ratio ranged from 2 to 5:1 [14-16]. HLA-B27 was present in 40.6% of the subjects with MRI (+) sacroiliitis, similar to a previous report by Pagnini et al in 17 children with enthesitis-related arthritis (ERA) and sacroiliitis [17], but much less than reported in adult AS where HLA-B27 was present in >90% [18]. …”

Section: Discussionsupporting

confidence: 90%

Magnetic resonance imaging findings in juvenile spondyloarthropathy and effects of treatment observed on subsequent imaging

Lin

MacKenzie²,

Courtier³

et al. 2014

Pediatr Rheumatol

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BackgroundMagnetic resonance imaging (MRI) is often used to diagnose and monitor treatment effects of juvenile spondyloarthropathy (SpA). Our objective was to describe MRI findings in juvenile SpA and determine predictors of active sacroiliitis and response to treatment.MethodsChildren who had MRI of the sacroiliac (SI) joints and were referred to the pediatric rheumatology clinic from 2009 to 2012 were retrospectively studied. The clinical parameters, laboratory studies and findings on MRI were collected and a composite score ratio (CR) was calculated for both SI joints on each MRI study based on a semi-quantitative scale that included evaluation of bone marrow edema (BME), synovial enhancement (SE), and erosions (ER). The findings on MRI were correlated with clinical and laboratory values.Results50 subjects who underwent 76 MRI for suspected or known SpA were included in the study. Sacroiliitis was seen in 48 MRIs in 32 subjects. Of the subjects with sacroiliitis, mean age ± standard deviation was 13.7 ± 2.6 years, 71% were male and 41% were HLA B27 positive. SE without BME was seen in 31% cases of sacroiliitis. In subjects with sacroiliitis, 79% also had hip arthritis and 41% had enthesitis of the pelvic region on MRI. In 38% of subjects with sacroiliitis, physical exam was not indicative of sacroiliitis or hip arthritis. Longitudinal data were available for 13 subjects. Sacroiliitis on MRI improved in 9 subjects with the greatest improvement in MRI composite score ratio after initiation of etanercept therapy. CR improvement was due to improvement of BME and SE components, while the ER score remained the same or worsened in all but 1 subject.ConclusionHistory, physical exam or laboratory data may not predict sacroiliitis in children. Magnetic resonance imaging plays a valuable role in the initial evaluation and later treatment monitoring of children with spondyloarthropathy. Synovial enhancement is significantly reduced after treatment, and unlike adults, synovial enhancement may be detected without accompanying bone marrow edema, which suggests gadolinium contrast may be an important component in the assessment of children with spondyloarthropathy.

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Section: Discussionsupporting

confidence: 90%

Magnetic resonance imaging findings in juvenile spondyloarthropathy and effects of treatment observed on subsequent imaging

Lin

MacKenzie²,

Courtier³

et al. 2014

Pediatr Rheumatol

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“…Hip joint involvement is more common in ERA as compared to adult SpA and portends a poorer prognosis [21]. Hip arthritis, number of active joints, and number of entheseal sites at onset positively correlate with presence of sacroiliitis, whereas presence of dactylitis has a negative correlation with the same [20,22].…”

Section: Axial Arthritismentioning

confidence: 93%

“…MRI features of active sacroiliitis are subchondral or periarticular bone marrow edema on STIR imaging or osteitis on T1 post-Gadolinium images; in the absence of bone marrow edema, the presence of enthesitis, synovitis, or capsulitis, although consistent with sacroiliitis, is not suggestive of active sacroiliitis. Preferably, a STIR image is obtained, with contrast avoided if possible in children [8,20,22]. Radiological sacroiliitis occurs late in patients with ERA (Fig.…”

Section: Axial Arthritismentioning

confidence: 98%

Enthesitis-related arthritis

Aggarwal

Misra

2015

Clin Rheumatol

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Juvenile idiopathic arthritis (JIA) is the most common chronic arthritis of childhood. Currently, it is characterized by seven categories. The enthesitis-related arthritis (ERA) category usually affects boys older than 6 years and presents with lower limb asymmetrical arthritis associated with enthesitis. Later, these children can develop inflammatory lumbosacral pain (IBP). These children are at risk of developing acute anterior uveitis. A recently devised disease activity index, Juvenile Spondyloarthropathy Disease Activity Index (JSpADA), has been validated in retrospective cohorts. The corner stone of treatment is NSAIDs, local corticosteroid injections, and exercise. Methotrexate and sulfasalazine can be used for peripheral arthritis while anti-tumor necrosis factor (TNF) agents are sometimes used to treat refractory enthesitis and sacroiliitis. Almost two third of patients with ERA have persistent disease and often have impairments in their quality of life. The presence of hip or ankle arthritis and a family history of spondyloarthropathy or polyarticular joint involvement at onset are associated with poorer prognosis.

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“…In addition, patients might have long periods of remission, although "outgrowing" jSpA is not an expectation. In the pre-anti-TNF therapy reported remission rates of ERA following treatment and prior to adulthood range from 17% to 37%, and the risk of developing sacroillitis within the first 5 years after diagnosis ranges from 6% to approximately 50% across studies (Flato, Smerdel et al 2002;Pagnini, Savelli et al 2010; www.intechopen.com Stoll, Bhore et al 2010). Long term outcome is rather impaired as illustrated by a retrospective study by Flato et al (Flato, Hoffmann-Vold et al 2006) and by Minden et al (Minden, Niewerth et al 2002).…”

Section: Prognosismentioning

confidence: 99%