Juvenile Spondyloarthritis

Juvenil Spondiloartrit Nedir?

Juvenile Spondyloarthritis / Enthesitis-Related Arthritis is a group of chronic inflammatory diseases characterized by inflammation in the joints (arthritis) and inflammation at the sites where tendons and ligaments attach to certain bones (enthesitis). It predominantly affects the extremities and, in some cases, the joints of the pelvis and spine (sacroiliitis – inflammation of the hip girdle and spondylitis – involvement of the back/spine).

What Causes Juvenile Spondyloarthritis?

Although the exact cause of spondyloarthritis is unknown, it is known that 20% of patients have first- or second-degree relatives with the disease. Juvenile SpA-EIA is more common in people who are positive for HLA-B27, a genetic factor.

What are the Symptoms of Juvenile Spondyloarthritis?

The most common symptoms are;

• Pain in joints
• Swelling
• It is the limitation of joint movements.

The most commonly affected joints are; knee, ankle, metatarsal bones (midfoot) and hip joints, and less commonly, small joints of the foot may also be affected. In some children, arthritis can occur in the arm joints, especially the shoulders. Enthesitis is inflammation of the enthesis (where a tendon or ligament attaches to bone) and is the second most common manifestation of the disease in children with SpA-ERA.

The heel, midfoot and kneecap are frequently affected areas. Back pain is due to Spine involvement, is very rare in the beginning and occurs in some children in the advanced stages of the disease. The most common complaint in these patients is waist and hip pain, which wakes them up from sleep, especially in the morning, and prevents the patient from even moving in bed. Lumbar stiffness may also occur. These complaints decrease with movement during the day.

The most common symptoms are waist/back pain at night, stiffness in the morning and limitation of movement. Acute anterior uveitis (inflammation of the eye) may occur in one third of patients;

Some children with inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis, may develop spondyloarthropathy. In some children, intestinal inflammation is silent (without symptoms of digestive tract involvement) and symptoms of joint involvement are more severe and require special treatment.

How to Diagnose Juvenile Spondyloarthritis?

In children younger than 16 years of age, it is placed according to specific clinical and radiographic findings. A positive HLA-B27 test is useful for diagnosing juvenile SpA-EIA, especially in children with a single symptom. The presence of the HLA-B27 marker alone is not sufficient for diagnosis, but its compatibility with SpA-EIA clinical characteristic signs and symptoms is important. Tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can provide information about the occurrence of widespread inflammation and thus indirectly the activity of the disease.

How Is Juvenile Spondyloarthritis Treated?

• Treatment for SpA may vary depending on your child’s symptoms, age and development, and other conditions. It may include medications and/or physical therapy.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
• Disease-modifying anti-rheumatic drugs (DMARDS), such as methotrexate.
• In children who cannot achieve full recovery despite disease-modifying anti-rheumatic drugs such as methotrexate, biological drugs such as adalimumab or etanercept can be added to the treatment.
• In most cases, physical therapy and exercises are required to strengthen their joints, stretch the back, and promote mobility.