Enthesitis-related arthritis: the clinical characteristics and factors related to MRI remission of sacroiliitis

Abstract

Background To describe the clinical characteristics and explore the factors related to the MRI remission of sacroiliitis in patients with enthesitis-related arthritis (ERA). Methods Patients with ERA from 2018–2022 in our medical center were retrospectively reviewed, which identified according to Pediatric Rheumatology International Trials Organization (PRINTO) criteria. Demographics, clinical characteristics, examinations, and treatments were described. Univariate and multivariate logistic regression models were used to analyze the factors related to MRI remission of sacroiliitis in ERA. Results This retrospective study included 160 ERA patients (51.9% male) with a mean onset age of 9.2 ± 3.0 years. There were 144 cases (81.9%) with peripheral arthritis, and the hip, knee, and ankle joints were the most commonly involved joints. Enthesitis occurred in 48 cases (30.0%), and sacroiliitis occurred in 142 cases (88.5%) at diagnosis. Human leukocyte antigen (HLA)-B27 was positive in 33 cases (17.1%), and acute uveitis occurred in 3 cases (1.9%). The majority of patients (93.7%) were treated with disease-modifying anti-rheumatic drugs (DMARDs), and 60% with biologics. Among 62 patients with MRI-defined sacroiliitis, 27 (43.5%) cases showed improvement in the sacroiliac joint lesion after treatment. Multivariate logistic regression analysis showed that duration from onset to diagnosis of less than 3 months (OR = 3.609, 95% CI: 1.068–12.192) and active joints of more than 4 (OR = 4.916, 95% CI: 1.006–24.037) were independent factors. Conclusion We highlighted differences in ERA clinical characteristics. Patients with a shorter diagnosis time and more joint involvement improved more significantly in sacroiliac joint lesions after treatment.

High prevalence of sacroiliitis and early structural changes in the sacroiliac joint in children with enthesitis-related arthritis: findings from a tertiary centre in Hong Kong

“…Our result is more consistent with the French cohort, in which, 63% had axial symptoms and 47% developed sacroiliitis at a median time of 2.6 and 5.3 years respectively [ 9 ]. On the other hand, Li [ 17 ] found 88.5% ERA patients had sacroiliitis at diagnosis in a retrospective study done in Shanghai. Together, these results suggested that axial involvement might occur early in the disease course and more frequently than expected in children with ERA.…”

Whole-Body MRI at Initial Presentation of Chronic Recurrent Multifocal Osteomyelitis, Juvenile Idiopathic Arthritis, Their Overlapping Syndrome, and Non-Specific Arthropathy

“…Enthesitis is a predominant finding in juvenile spondyloarthritis and has been shown to affect 60-80% of JIA patients [11,50,51]. Characteristic locations include the following: the inferior pole of the patella, ischial tuberosity and various ligamentous and muscular attachments of the pelvis, and greater trochanter and calcaneus [11].…”

Effects of a home-based exercise combined yoga and resistance training in enthesitis-related arthritis in China: study protocol for a randomised controlled trial

“…In seven categories, enthesitis-related arthritis (ERA) is the most common subtype in Southeast Asia affecting approximately 30% of all JIA and is associated with a poorer prognosis than other subtypes 3 4. Distinguishing clinical characteristics related to ERA include probable enthesitis and spinal involvement, and peripheral arthritis often presents as asymmetric arthritis of the lower extremities 5 6. These arthritis symptoms can lead to muscle weakness around the involved joints, limited range of joint motion, impaired aerobic fitness, fatigue, and resultant decreased function ability, reduced physical activity (PA), and an increase in the risk of fracture 7 8.…”