Clinical and therapeutic aspects of juvenile-onset spondyloarthropathies

Juvenile idiopathic arthritis

Juvenile idiopathic arthritis is a broad term that describes a clinically heterogeneous group of arthritides of unknown cause, which begin before 16 years of age. This term encompasses several disease categories, each of which has distinct methods of presentation, clinical signs, and symptoms, and, in some cases, genetic background. The cause of disease is still poorly understood but seems to be related to both genetic and environmental factors, which result in the heterogeneity of the illness. Although none of the available drugs has a curative potential, prognosis has greatly improved as a result of substantial progresses in disease management. The most important new development has been the introduction of drugs such as anticytokine agents, which constitute a valuable treatment option for patients who are resistant to conventional antirheumatic agents. Further insights into the disease pathogenesis and treatment will be provided by the continuous advances in understanding of the mechanisms connected to the immune response and inflammatory process, and by the development of new drugs that are able to inhibit selectively single molecules or pathways.

Juvenile spondyloarthropathies

This paper reviews the recent literature on the juvenile spondyloarthropathies. Several case reports emphasized clinical characteristics of the spondyloarthropathies including reactive arthritis. MR imaging seemed to enhance the detection of sacroiliitis in children with spondyloarthropathies. The presence of different cytokines in various forms of juvenile arthritis including the juvenile spondyloarthropathies was investigated and suggested a role for the anti-inflammatory cytokines in milder disease. Evidence for the association of low-molecular-weight polypeptide gene polymorphism with susceptibility to acute anterior uveitis was found in a Mexican population of patients with spondyloarthropathies, including 80 with juvenile spondyloarthropathy. A review of therapeutic use of sulfasalazine in children with chronic arthritis, including those with juvenile spondyloarthropathy, concluded that it was safe and effective. Last, a study assessed aerobic fitness and physical activity in patients with juvenile spondyloarthropathy in remission and suggested a decline in physical fitness in older patients.