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Outcomes in Juvenile-Onset Spondyloarthritis
Judith A Smith1, Ruben Burgos-Vargas2
1Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
Insights
Juvenile onset spondyloarthritis (JoSpA) in children often leads to poor outcomes and difficulty achieving remission. Early recognition of JoSpA
Area of Science:
- Pediatric Rheumatology
- Immunology
- Inflammatory Diseases
Background:
- Juvenile onset spondyloarthritis (JoSpA) is associated with poorer functional status and remission rates compared to other juvenile idiopathic arthritis (JIA) categories.
- Early identification and risk stratification are crucial for managing JoSpA.
- Understanding JoSpA's unique characteristics is vital for improving patient outcomes.
Purpose of the Study:
- To review the clinical burden of disease, prognostic indicators, and outcomes in JoSpA.
- To highlight the importance of recognizing unique JoSpA characteristics for earlier diagnosis and risk stratification.
Main Methods:
- Review of existing literature on juvenile onset spondyloarthritis.
- Analysis of clinical characteristics, disease progression, and treatment outcomes.
- Examination of prognostic indicators and the impact of therapies like TNF inhibitors.
Main Results:
- Children with JoSpA often present with less axial disease initially but a significant percentage (34-62%) show active inflammation on MRI without back pain.
- Over half of children with enthesitis-related arthritis (ERA) develop axial disease within five years.
- Despite TNF inhibitor efficacy, over a third of patients experience persistent active disease.
Conclusions:
- Axial disease, particularly sacroiliitis, indicates ongoing active disease in JoSpA.
- While TNF inhibitors have improved outcomes, further therapeutic advancements are needed for JoSpA.
- Improving the long-term outlook for children with JoSpA requires continued research and development of new treatments.
Abstract:
Some studies have suggested children with juvenile onset spondyloarthritis (JoSpA) have a relatively poor outcome compared to other juvenile idiopathic arthritis (JIA) categories, in regards to functional status and failure to attain remission. Thus, in the interest of earlier recognition and risk stratification, awareness of the unique characteristics of this group is critical. Herein, we review the clinical burden of disease, prognostic indicators and outcomes in JoSpA. Of note, although children exhibit less axial disease at onset compared to adults with spondyloarthritis (SpA), 34-62% have magnetic resonance imaging (MRI) evidence for active inflammation in the absence of reported back pain. Furthermore, some studies have reported that more than half of children with "enthesitis related arthritis" (ERA) develop axial disease within 5 years of diagnosis. Axial disease, and more specifically sacroiliitis, portends continued active disease. The advent of TNF inhibitors has promised to be a "game changer," given their relatively high efficacy for enthesitis and axial disease. However, the real world experience in various cohorts since the introduction of more widespread TNF inhibitor usage, in which greater than a third still have persistently active disease, suggests there is still work to be done in developing new therapies and improving the outlook for JoSpA.
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