Presentation of enthesitis-related arthritis and juvenile-onset spondyloarthritis: a cross-sectional study in a pediatric and adult clinic

• Published in: Advances in rheumatology (London, England) Vol. 64; no. 1; pp. 39 - 8
• Main Authors: Lanças, Sean Hideo Shirata, Furlan, Matheus Zanata Brufatto, Fernandes, Taciana de Albuquerque Pedrosa, Drumond, Sula Glaucia Lage, Magalhães, Claudia Saad
• Format: Journal Article
• Language: English
• Published: England Sociedade Brasileira de Reumatologia 08-05-2024; BMC
• Subjects: Adolescent; Adult; Age of Onset; Antirheumatic Agents - therapeutic use; Arthritis, Juvenile - complications; Arthritis, Juvenile - diagnosis; Arthritis, Juvenile - drug therapy; Child; Classification; Cross-Sectional Studies; Disease Progression; Enthesitis-related arthritis; Enthesopathy - diagnostic imaging; Enthesopathy - etiology; Female; Humans; Juvenile idiopathic arthritis; Male; Outcome; Retrospective Studies; RHEUMATOLOGY; Sacroiliitis - diagnostic imaging; Spondylarthritis - complications; Spondylarthritis - diagnosis; Spondylarthritis - drug therapy; Spondyloarthritis; Spondyloarthropathy; Spondyloarthropathy; Spondyloarthritis; Outcome; Enthesitis-related arthritis; Classification; Juvenile idiopathic arthritis
• ISSN: 2523-3106; 2523-3106
• DOI: 10.1186/s42358-024-00378-8

Juvenile idiopathic arthritis (JIA) comprises a whole spectrum of chronic arthritis starting before 16 years of age. The study aims to explore the clinical and demographic descriptors, treatment, and disease progression of enthesitis-related arthritis (ERA) in comparison with juvenile-onset spondyloarthritis (SpA).
Cross-sectional analysis of consecutive patients in two dedicated clinics, with a single visit and retrospective case-notes review. Arthritis, enthesitis and sacroiliitis were evaluated by scoring disease activity and damage. Continuous variables were reported by median, interquartile range; categorical variables were reported by the frequency comparison of the two groups.
Thirty-three cases were included, being 23 (69.7%) with ERA. The median age at diagnosis was 12.5 y (SpA) vs. 9 y (ERA) (p < 0.01); the time from symptom onset to diagnosis was 5.5 y (SpA) vs. 1.5 y (ERA) (p < 0.03). In both groups, the predominant presentation was a single joint or < 5 lower limb joints and asymmetric involvement, with a high frequency of enthesitis. There was a higher frequency of mid-tarsal and ankle synovitis in the ERA group and hip involvement in those with SpA. The comparison of the frequency of spine symptoms at presentation, 30% SpA vs. 21.7% ERA (p = 0.7), was not significant, and radiographic progression to spinal involvement occurred in 43.5% of ERA patients. The median time for spinal progression and age at onset was 2.2 and 12 y for ERA, and 4 and 16.5 y for SpA, respectively. Activity and damage scores were not significantly different between the groups. Treatment comparison resulted in 91.3% of ERA and 100% SpA being treated, predominantly with NSAIDs in both groups, followed by DMARDs and biologics, with a higher frequency of biologics in SpA.
The main differences were the late diagnoses of SpA, and the hip and spine involvement, with higher frequency of biologic treatment in juvenile-onset SpA compared to ERA.