Juvenile Spondyloarthritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: High Biologic Use, Low Prevalence of HLA–B27, and Equal Sex Representation in Sacroiliitis

Abstract

Objective To describe characteristics of children with enthesitis‐related arthritis (ERA) and juvenile psoriatic arthritis (PsA) who were enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry. Methods All children with ERA and those with juvenile PsA were identified. Demographic characteristics, clinical characteristics, and treatments were described. The children with sacroiliitis and those without sacroiliitis were compared. In the children with sacroiliitis, the first visit with clinically active sacroiliitis (which came first in 72% of cases) was compared to the first visit without clinically active sacroiliitis. Results A total of 902 children with ERA or juvenile PsA were identified. Children with ERA were older at diagnosis (ages 10.8 years versus 8.2 years; P < 0.01) and were more likely to be male (56% versus 38%; P < 0.01). Polyarticular involvement was reported in 57% of children with ERA and in 72% of those with juvenile PsA. Of the children tested, HLA–B27 was positive in 38% of those in the ERA group and in 12% of those in the juvenile PsA group. At least 1 biologic was taken by 72% of those with ERA and 64% of those with juvenile PsA. Sacroiliitis (diagnosed clinically and/or by imaging) was reported in 28% of the children (40% of those with ERA and 12% of those with juvenile PsA). Of these, 54% of the children were female, 36% were HLA–B27 positive, and 81% took at least 1 biologic. In children with sacroiliitis, scores according to the physician global assessment of disease activity, parent/patient global assessment of well‐being, and clinical Juvenile Arthritis Disease Activity Score 10 were all significantly worse at the first visit with clinically active sacroiliitis versus the first visit without active sacroiliitis. Conclusion In this registry, there are more than 900 children with ERA or juvenile PsA. There was high biologic use in this population, especially in those with sacroiliitis. Further, there was equal sex representation in those children with sacroiliitis.

Preliminary Results of first Belgian Cohort of Juvenile Idiopathic Arthritis: Where Do we Stand in Terms of Quality of Care and Remission?

“…This non-systematic search is probably guided by the fact that the analysis is not reimbursed for patients, and is therefore essentially performed if the clinical picture can t within the ILAR classi cation criteria of the ERA-subtype of JIA (or requires the removal of exclusion criterion b in a boy over 6 years of age at disease onset). The rates found in our cohort are in fact similar to those found in populations of the ERA type [27]. Interestingly, the patients included in this cohort were generally treated in accordance with the last ACR recommendations, with intra-articular corticoids preferentially used in oligoarthritis forms, methotrexate as a rst DMARD and biotherapies as a second line of treatment (in the non-systemic forms) [4,5].…”

Determinants of Tumor Necrosis Factor Inhibitor Use in Juvenile Spondyloarthropathy and Impact on Clinical Disease Outcomes

“…Of the patients who had a documented HLA antigen B27 test result, the percentage of patients who were HLA antigen B27–positive in our cohort was smaller (38%) when compared with the other cohorts. However, another study suggested the prevalence may be closer to 50% in the pediatric population ( 21 ), and a more recent study reported a similar HLA antigen B27 positivity finding of 36% ( 22 ).…”

A randomized, double-blind, placebo-controlled 12-week trial of infliximab in patients with juvenile-onset spondyloarthritis

“…Disease activity at baseline predicted functional impairment by 10 years in 60% of patients [33,35,36]. Moreover, patients with JoSpA score higher in CHAQ [32,37] and bodily pain [38,39] than other JIA categories.…”