Enthesitis-related arthritis

Abstract

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.

Juvenile Idiopathic Arthritis

“…The increased frequency of autoimmune diseases among JIA patients suggests the genetic basis of the disease (11). Human leukocyte antigen (HLA) B27 and the other HLA tissue types are the most commonly mentioned genetic factors (3,12,13,14,15). Various infections are considered to be responsible for JIA pathogenesis: enteric infections, parvovirus B19, rubella, mumps, hepatitis B, Epstein-Barr virus, mycoplasma and chlamydia infections (2,16).…”

“…For years, different names were used for the same clinical entity, including type 2 oligoarticular JIA, JCA with late onset, seronegative enthesopathy and arthropathy, arthropathy associated with HLA B27 or juvenile spondyloarthropathy with early onset. The term ERA is defined by Durban classification (3,4,13). The disease is typically seen among males, after the age of six.…”

“…The main characteristics of the patients include RF and ANA negativity with findings of enthesopathy and asymmetric arthritis of the lower extremities. HLA B27 positivity is reported in 65-80 % of patients (13). Enthesopathy represents the inflammation of the attachment sites of the tendons to the bones.…”

“…The affected site is characterized by pain and sensitivity. However, enthesopathy can be seen in different conditions, such as familial Mediterranean fever, Behçet’s disease, Osgood-Schlatter syndrome and fibromyalgia (12,13). Typical joint involvement is asymmetric oligoarticular lower-extremity arthritis with the knee and ankle being most commonly affected.…”

Alteration of Fecal Microbiota Profiles in Juvenile Idiopathic Arthritis. Associations with HLA-B27 Allele and Disease Status

“…According to several factors, including the number of affected joints, JIA is divided in psoriatic, oligoarticular (up to four affected joints), polyarticular (five or more affected joints) (Oberle et al, 2014), and enthesitis-related arthritis (ERA), in which entheses (attachments of tendons and ligaments to bone) are affected. ERA accounts for 10–20% of JIA and is considered the equivalent of spondyloarthropathy, a disease frequently characterized by clinical and subclinical intestinal involvement (Bryan and Rabinovich, 2014; Oberle et al, 2014; Aggarwal and Misra, 2015). …”