Background/Purpose: :  Juvenile spondyloarthropathies (JSpA) are a group of chronic childhood rheumatic diseases which emerge especially before 16 and after 6 years-old. While enthesitis and oligoarthritis are the major signs of the early period, axial skeletal involvement and sacroiliitis are the late period signs. Although the diagnosis of the spondyloarthropathy is easy in adults, it is quite difficult in children. The aim of the study to determine clinical and demographical features of the JSpA cases that is followed-up in our department, and to evaluate treatment modalities and long term complications of disease together with the side effects of the drugs. 

Methods: 107 children (21 female, 86 male) that admitted to our clinic with the diagnosis of JSpA between January 2005-December 2014 were involved in our study. Enthesitis related arthritis and Juvenile Ankylosing Spondylitis were included under the topic of JSpA. Clinical and laboratory variables were obtained from patient records.

Results:  While the mean age of the disease onset and diagnosis were 11,4±3 years (range 3 -17 years) and 12,4±2,8 years (range 5-18 years) respectively, the mean duration of follow-up period was 2,7±2,5 years (range 2 months-12 years). Lower extremity arthritis (n=83, 77,6%), hip pain (n=63, 58,9%) and inflammatory low back pain (n=47, 43,9%) were the major clinical findings. The most seen involvement of the lower extremity was ankle joint arthritis (n=60, 72,3%) followed by enthesitis (n=76, 71%) and tarsitis (n=30, 28%). Axial skeletal involvement was noted in 57% (n=61) of patients and mean inflammatory low back pain duration was 8,3±6,9 months (range 1-24 months). Magnetic resonance imaging could be studied in 77 patients (72%) that imaging results of 52 children (48,6 %) were consistent with sacroiliitis. Lumbar movement limitation in Schober’s test was seen in 42 cases (39.3%). Family history of spondylitis in 29 children (27.1%) and familial Mediterranean fever (FMF)  in 4 cases. Furthermore, 5 patients diagnosed as FMF and treated with colchicine. None of the family history were consistent with inflammatory bowel disease. Uveitis was seen in 11 children (10.3). HLA-B27 was positive in 73.8 % (n=79) of the patients. First line therapies were methotrexate in 51 patients (47.5%) and sulphasalazine in 40 cases (37.4%). Anti-TNF alpha agents were used in 51 patients (47,7%) that were resistant to first line therapy. In the last medical visits we evaluated the patients in the terms of treatment modalities; 60.7% (n=65) of cases were noted as using drugs and in remission, 12.1% (n=13) gave up drugs and in remission, 16.8% (n=18) as minimally active and 6,5% (n=7) as active.

Conclusion: Initial signs of JSpA are usually lower extremity arthritis and enthesitis in children that is quite different from adults. JSpA should be strongly suspected in the case of a boy that is older than 6 years-old with lower extremity arthritis and the family history of spondyloarthropathy. Afterwards, axial skeletal evaluation must be investigated immediately and in order to prevent this complication true and efficient therapy must be started. FMF should be kept in mind in the differential diagnosis of JSpA in our country.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/juvenile-spondyloarthropathies-a-single-center-experience/