The early clinical recognition of juvenile‐onset ankylosing spondylitis and its differentiation from juvenile rheumatoid arthritis

Abstract

Objective. To determine which early clinical data differentiate juvenile-onset ankylosing spondylitis (AS) from juvenile rheumatoid arthritis (JRA).Methods. Medical records of 35 patients with juvenile-onset AS and 75 with JRA (excluding type I1 pauciarticular JRA), all of whom had disease onset at age 516 years, disease duration of 52% years at the initial visit to the rheumatology clinic, and followup of 2 10 years, were analyzed retrospectively with regard to features of disease found 6 months, 12 months, and 10 years after onset.Results. At 6 months, various features appeared more frequently in the juvenile-onset AS group than in the JRA group, i.e., pauciarthritis (54.3% versus 30.7%; P = 0.03, odds ratio [OR] = 2.7), enthesopathy (82.9% versus 0%; P < 0.0001, OR = 321.4), tarsal disease (71.4% versus 1.3%; P < 0.0001, OR = 185.0), and lumbar/sacroiliac symptoms (11.4% versus 0%; P = 0.02, OR = 11.9). At 12 months, the features found more frequently among juvenile-onset AS patients than JRA patients were enthesopathy (88.6% versus 4.0%; P < 0.0001, OR = 186.0), tarsal disease (85.7% versus 10.7%; P < 0.0001, OR = 50.3), and knee disease (100.0% versus 82.7%; P = 0.04, OR = 8.0). Involvement of the upper extremities (especially the hands) was found in significantly fewer juvenile-onset AS patients compared with the JRA group. Definite involvement of the spine and sacroiliitis in juvenile-onset AS occurred after a mean & SD of 7.3 f 2.0 years.Conclusion. Regardless of axial disease, enthes-

From Retrospective Analysis of Patients with Undifferentiated Spondyloarthritis (SpA) to Analysis of Prospective Cohorts and Detection of Axial and Peripheral SpA

“…In children, the proportion of patients with USpA and USpA-like clinical forms fulfilling AS criteria throughout the followup period ranges from 66% to 90% within 10 years of disease [27][28][29][30] .…”

A Randomized, Double‐Blind, Placebo‐Controlled Multicenter Study of Adalimumab in Pediatric Patients With Enthesitis‐Related Arthritis

“…A small number of patients were available for study enrollment due to the rarity of the disease. ERA patients tend to have few joints involved, although in our refractory population, the mean AJC at baseline was high, indicating more severe disease 2, 40 and reflecting longer disease duration 41. While there were no statistical differences in baseline disease activity between the placebo and adalimumab treatment groups, it is acknowledged that there is potential for numerical differences to affect outcome, given the small sample size of the study.…”

Associação entre os níveis séricos de potenciais biomarcadores com a presença de fatores relacionados à atividade clínica e ao mau prognóstico em espondiloartrites

“…The initial stages of these diseases are associated with joint infl ammatory compromise and enthesitis of the lower limbs. [7][8][9] Some characteristics related to the onset of the disease, such as age at onset, HLA-B27, symptom duration of the fi rst episode, and male gender, among others, may determine the clinical expression and evolution of SpA. In general, men present more severe forms and have greater axial compromise, while women have a greater peripheral joint compromise and less sacroiliitis.…”