Hip involvement in children with enthesitis related arthritis (ERA) is associated with poor outcomes in adulthood

Abstract

Background The data on long-term outcome in enthesitis-related arthritis (ERA), the commonest category of JIA in India, is scant. Thus, we studied outcomes of ERA in a resource-constrained setting. Methods Patients with ERA (ILAR classification) (≥ 5 years of disease and ≥ 18 years) were included. Data on clinical features, Bath indices (BASMI, BASDAI, BASFI), ASDAS, and health assessment questionnaire-disability index (HAQ-DI) was collected. X-ray pelvis including hips was obtained and compared with baseline X-ray for progression of sacroiliitis and hip arthritis. Fulfillment of adult criteria of spondyloarthropathy (SpA) were also assessed. Results Seventy-three 73 patients (72 males) of median age 20 (18-23) years and disease duration 8 (5.5-11) years were recruited. There was delay in diagnosis of 4 (1.75-6) years. Thirty-nine (53%) had BASDAI ≥ 4 and 63 (91%) had ASDAS-CRP > 1.3. Two-third (60%) had functional disability (HAQ-DI ≥ 0.5). Poor outcome (BASDAI ≥ 4, ASDAS > 2.1, BASFI > 0.9, or HAQ-DI ≥ 0.5) was seen in three-fourths (n = 56.76%) of patients and was associated with hip involvement, HLA-B27 positivity, and fulfillment of axial ASAS criteria. Sixty-seven (91%) patients fulfilled axial ASAS criteria, while 71 (97%) fulfilled peripheral ASAS criteria. Overall, 81% had X-ray sacroiliitis and 37% had hip involvement. Nearly half (46.6%) and one-fourths (25%) of the patients had X-ray sacroiliitis and hip arthritis progression, respectively. Those with X-ray hip arthritis had longer delay in diagnosis (6 vs 3 years), higher Bath indices, ASDAS, and HAQ-DI. Hip arthritis correlated with radiological sacroiliitis (r = 0.301). Fulfillment of modified NY criteria was seen more often in patients with hip arthritis (95 vs 63%; p < 0.002). Conclusion Most ERA patients had active disease in adulthood. Hip involvement, axial involvement, and HLA-B27 positivity were predictors of poor outcome. Key Points• Almost 90% of adults with ERA had active disease even after 8 years of disease.• Poor outcomes were seen in three-fourths of patients and hip involvement, presence of HLA B27, and axial involvement were the predictors of poor outcome.

Axial Involvement in Enthesitis-Related Arthritis: Results from a Single-Center Cohort

“…Hip involvement is a poor prognostic factor for ERA, which increases the risk of sacroiliac arthritis [33][34][35]. These various factors could explain why nearly half of our patients with axial ERA were prescribed biological therapy at disease onset.…”

The Juvenile Spondyloarthritis Disease Activity Index Is a Useful Tool in Enthesitis-Related Arthritis

“…Similarly, the ICON-JIA (Inception Cohort of Newly Diagnosed Patients With JIA) study reported that a higher baseline ESR in 266 JIA patients indicated an increased risk for continued disease activity 12 months later 23 . On the other hand, it was also found that baseline high ESR had no role in the long-term prognosis of ERA patients with more than 10 years of follow-up 24 . Kısaarslan et al 25 reported that acute phase reactants at admission were higher in ERA patients who did not respond to conventional DMARDs.…”

“…23 On the other hand, it was also found that baseline high ESR had no role in the long-term prognosis of ERA patients with more than 10 years of follow-up. 24 Kısaarslan et al 25 reported that acute phase reactants at admission were higher in ERA patients who did not respond to conventional DMARDs. However, they found that elevated acute phase reactants at baseline did not affect the time to treatment switch.…”

Axial involvement in enthesitis-related arthritis: results from a single-center cohort

“…Hip involvement is a poor prognostic factor for ERA, which increases the risk of sacroiliac arthritis [ 32 , 33 ]. These various factors could explain why nearly half of our patients with axial ERA were prescribed biological therapy at disease onset.…”