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Review
. 2015 Jul;27(4):364-72.
doi: 10.1097/BOR.0000000000000185.

Juvenile spondyloarthritis

Sabrina Gmuca  1 , Pamela F Weiss
Affiliations
Review

Juvenile spondyloarthritis

Sabrina Gmuca et al. Curr Opin Rheumatol. 2015 Jul.

Abstract

Purpose of review: This article provides a comprehensive update of the pathogenesis, diagnostic imaging, treatments, and disease activity measurements of juvenile spondyloarthritis (JSpA).

Recent findings: Genetic and microbiome studies have provided new information regarding possible pathogenesis of JSpA. Recent work suggests that children with JSpA have decreased thresholds for pain in comparison to healthy children. In addition, pain on physical examination and abnormalities on ultrasound of the entheses are not well correlated. Treatment guidelines for juvenile arthritis, including JSpA, were published by the American College of Rheumatology and are based on active joint count and presence of sacroiliitis. Recent studies have established the efficacy of tumor necrosis factor inhibitors in the symptomatic treatment of axial disease, although their efficacy for halting progression of structural damage is less clear. Newly developed disease activity measures for JSpA include the Juvenile Arthritis Disease Activity Score and the JSpA disease activity index. In comparison to other categories of juvenile arthritis, children with JSpA are less likely to attain and sustain inactive disease.

Summary: Further microbiome and genetic research may help elucidate JSpA pathogenesis. More randomized therapeutic trials are needed and the advent of new composite disease activity measurement tools will hopefully allow the design of these greatly needed trials.

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Conflict of interest statement

Conflicts of interest: None

Figures

Figure 1
Figure 1. Enthesitis in JSpA
Quadriceps tendon enthesitis in a 12-year-old boy. (A) Long, grayscale ultrasound image demonstrates focal hypoechogenicity within the distal aspect of the quadriceps tendon (arrow) which is confirmed on the transverse image (B) with mild focal tendon enlargement (arrows). Long (C) and transverse (D) Power Doppler images demonstrates abnormal, increased signal within the tendon (dashed arrows) consistent with hyperemia. A small amount of joint fluid (arrow) is seen in D. Original figures provided courtesy of Nancy Chauvin, MD, Philadelphia, PA.
See this image and copyright information in PMC

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