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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).
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.
Reference
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.
