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Enthesitis-related arthritis.

Amita Aggarwal1, Durga Prasanna Misra2

  • 1Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareily Road, Lucknow, Uttar Pradesh, 226014, India. aa.amita@gmail.com.

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PubMed
Summary

Juvenile idiopathic arthritis (JIA), specifically the enthesitis-related arthritis (ERA) subtype, often persists into adulthood, impacting children's quality of life. Early identification of risk factors like hip/ankle involvement is crucial for better outcomes in juvenile arthritis patients.

Keywords:
Enthesitis-related arthritisJuvenile idiopathic arthritisOutcomesPathogenesisPrognosisTreatment

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Area of Science:

  • Pediatric Rheumatology
  • Immunology
  • Genetics

Background:

  • Juvenile idiopathic arthritis (JIA) is the most prevalent chronic arthritis in childhood, classified into seven categories.
  • Enthesitis-related arthritis (ERA), a JIA subtype, typically affects boys over six, presenting with asymmetrical lower limb arthritis and enthesitis, potentially leading to inflammatory lumbosacral pain and uveitis.

Purpose of the Study:

  • To review the characteristics, disease activity assessment, treatment strategies, and prognostic factors of the enthesitis-related arthritis (ERA) category of JIA.
  • To highlight the long-term implications and quality of life impairments associated with persistent ERA.

Main Methods:

  • Review of existing literature on Juvenile Idiopathic Arthritis (JIA) and its enthesitis-related arthritis (ERA) subtype.
  • Discussion of the validated Juvenile Spondyloarthropathy Disease Activity Index (JSpADA) for disease activity assessment.
  • Summary of current treatment modalities including NSAIDs, corticosteroids, DMARDs, and anti-TNF agents.

Main Results:

  • ERA often presents with lower limb arthritis and enthesitis, with a risk of developing inflammatory lumbosacral pain and uveitis.
  • A significant proportion (nearly two-thirds) of ERA patients experience persistent disease, leading to impaired quality of life.
  • Factors such as hip/ankle arthritis, family history of spondyloarthropathy, and polyarticular involvement at onset indicate a poorer prognosis.

Conclusions:

  • Enthesitis-related arthritis (ERA) is a significant subtype of JIA with a tendency for chronicity and potential long-term morbidity.
  • Effective management involves a combination of pharmacotherapy, local injections, and exercise, with advanced biologics for refractory cases.
  • Identifying prognostic indicators is essential for tailored management strategies and improving the long-term outlook for children with ERA.