Recent Advances in the Pharmacological Management of Pediatric Spondyloarthritis

Juvenile spondyloarthritis (JSpA) refers to a heterogeneous group of inflammatory diseases affecting peripheral joints and the axial skeleton during childhood and adolescence. Enthesitis-related arthritis (ERA) and juvenile psoriatic arthritis (JPsA), subtypes of juvenile idiopathic arthritis (JIA) under the International League of Associations for Rheumatology (ILAR) classification, are included in this group. They may be associated with human leukocyte antigen (HLA) B27 positivity. Apart from musculoskeletal involvement, pathologies that accompany the disease, such as psoriasis, uveitis, and inflammatory bowel disease, significantly affect patients' quality of life and clinicians' treatment approaches. Guidelines developed for the treatment of JSpA patients primarily address the use of nonsteroidal antiinflammatory drugs (NSAIDs), conventional disease-modifying antirheumatic drugs (csDMARDs), and tumour necrosis factor inhibitors (TNFi). However, not all patients respond adequately to or tolerate the currently available therapies, highlighting the need for novel treatment options. Recent advances in understanding immunopathogenesis have driven the development of new therapeutic targets, including TNF inhibitors, interleukin (IL)-17/IL-23 blockers, and Janus kinase inhibitors. Several of these agents, including secukinumab, have now received approval for the treatment of ERA and JPsA. However, since only a limited number of open-label and randomized controlled trials have specifically evaluated JSpA, current treatment strategies are also informed by evidence from other JIA subtypes and adult studies. Expanding the approved indications of existing biologics-supported by robust trial data-alongside the development of novel therapeutic agents, may broaden treatment options and ultimately improve outcomes for patients with JSpA.