Clinical Features Identified in Enthesitis-Related Juvenile Idiopathic Arthritis, Juvenile Spondyloarthritis

hands of a child with juvenile idiopathic arthritis
hands of a child with juvenile idiopathic arthritis
Results confirm that juvenile spondyloarthritis is characterized by its peripheral pattern at disease onset, with peripheral arthritis and enthesitis.

In most children with enthesitis-related arthritis or juvenile spondyloarthritis (SpA), axial involvement develops within 5 years, and the main risk factor for sacroiliitis and persistent active disease was a familial history of SpA, according to the results of retrospective study published in the Pediatric Rheumatology Online Journal.

The investigators retrospectively studied patients with childhood-onset spondyloarthropathies who were followed for >1 year at their referral center. Inclusion criteria were having enthesitis-related arthritis or juvenile SpA, with disease onset at <16 years. Patients with a personal or family history of psoriasis were not excluded from the study.

A total of 114 patients were followed between January 2008 and December 2015 for a median of 2.5 years. Overall, 69% of patients met the revised International League of Associations for Rheumatology (ILAR) classification criteria for enthesitis-related arthritis, and 92% fulfilled the Assessment of Spondyloarthritis International Society (ASAS) criteria for peripheral SpA (P <.001).

At disease onset, the presence of axial disease and sacroiliitis was rare. These conditions were reported at follow-up, however, in 63% and 47% of patients, respectively, after a median disease duration of 2.6 years (95% CI, 2.2-4.4) and 5.3 years (95% CI, 4.1-7.7), respectively.

Based on multivariable analysis, familial history of SpA was associated with the presence of sacroiliitis and active disease at the latest follow-up (odds ratio [OR], 3.61; 95% CI, 1.5-8.7; P <.01 and OR, 2.98; 95% CI, 1.2-7.3; P =.02, respectively).

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The investigators concluded that the use of revised Edmonton ILAR criteria was less sensitive than ASAS criteria for classifying patients as having childhood-onset spondyloarthropathies. The lack of sensitivity and specificity of the current revised Edmonton classification criteria suggests that improvement of classification criteria for juvenile idiopathic arthritis is warranted.

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Goirand M, Breton S, Chevallier F, et al. Clinical features of children with enthesitis-related juvenile idiopathic arthritis / juvenile spondyloarthritis followed in a French tertiary care pediatric rheumatology centre. Pediatr Rheumatol Online J. 2018;16(1):21.