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. 2018 Apr 2;16(1):21.
doi: 10.1186/s12969-018-0238-9.

Clinical features of children with enthesitis-related juvenile idiopathic arthritis / juvenile spondyloarthritis followed in a French tertiary care pediatric rheumatology centre

Maxime Goirand  1   2   3 , Sylvain Breton  4 , Frédéric Chevallier  5 , Ngoc-Phoi Duong  6   7 , Florence Uettwiller  6   8 , Isabelle Melki  6   8   9   10 , Richard Mouy  6   8 , Carine Wouters  6   8 , Brigitte Bader-Meunier  6   8 , Chantal Job-Deslandre  6 , Pierre Quartier  6   11   8
Affiliations

Clinical features of children with enthesitis-related juvenile idiopathic arthritis / juvenile spondyloarthritis followed in a French tertiary care pediatric rheumatology centre

Maxime Goirand et al. Pediatr Rheumatol Online J. .

Abstract

Background: Childhood-onset spondyloarthropathies usually start with enthesitis and peripheral arthritis. However, axial disease may develop afterward. Patients are most often classified, following revised (Edmonton 2011) ILAR criteria, as enthesitis-related arthritis, psoriatic arthritis, or unclassified juvenile idiopathic arthritis, particularly in cases of psoriasis in the patient or a first-degree relative. In adults, peripheral spondyloarthritis is classified by ASAS criteria.

Methods: We retrospectively studied patients with childhood-onset spondyloarthropathies followed for more than one year in our referral centre. We did not exclude patients with a personal or familial history of psoriasis.

Results: We included 114 patients followed between January 2008 and December 2015 for a median of 2.5 years (IQR = 2.3). Sixty-nine per-cent of patients fulfilled the revised ILAR classification criteria for enthesitis-related arthritis, and 92% the ASAS criteria for peripheral spondyolarthritis (p < 0.001). Axial disease and sacroiliitis were rare at disease onset. However, they appeared during follow-up in 63% and 47% of cases respectively, after a median disease duration of 2.6 (IC 95% [2.2-4.4]) and 5.3 years (IC 95% [4.1-7.7]), respectively. Multivariable analysis showed that familial history of spondyloarthritis was associated with the presence of sacroiliitis and active disease at the latest follow-up (OR = 3.61 [1.5-8.7], p < 0.01 and 2.98 [1.2-7.3], p = 0.02, respectively).

Conclusion: Axial involvement developed in most patients within five years. Revised Edmonton criteria were less sensitive than ASAS criteria to classify patients as having childhood-onset spondyloarthropathies. The main risk factor for both sacroiliitis and persistent active disease was a familial history of spondyloarthritis.

Keywords: Anti-TNF treatment; Classification criteria; Enthesitis related arthritis; Juvenile idiopathic arthritis; Juvenile spondyloarthritis; Prognostic factor.

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Conflict of interest statement

Ethics approval and consent to participate

The CEMARA system has authorisation from the French National Committee on Informatics and Liberty (CNIL). According to the French legislation, patients and parents were informed, but no informed consent form was required for a retrospective analysis.

Consent for publication

Not applicable

Competing interests

Maxime Goirand: invited to an international congress by Novartis. Richard Mouy, Brigitte Bader-Meunier, and Pierre Quartier: investigators in clinical trials on ERA for Abbvie and Pfizer. Pierre Quartier: consultant for Abbvie, speaker and congress invitations by Abbvie and Pfizer.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart. CEMARA, a French information system for rare disease. ERA, Enthesitis-related arthritis. JSpA, juvenile Spondyloarthritis
Fig. 2
Fig. 2
Evolution of axial disease prevalence. a Axial involvement (defined as: 1) inflammatory low back pain or inflammatory dorsal pain lasting for more than one month; 2) limited spine mobility; 3) sacroiliac pain at examination or intermittent buttock pain; or 4) presence of axial disease by imagery.). b Sacroiliitis Axial involvement was rare in the first years of the disease with a progressive linear increase in its prevalence up to 60 to 70% after five years
See this image and copyright information in PMC

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