Image guided sacroiliac joint corticosteroid injections in children: an 18-year single-center retrospective study

Treatment of non-systemic juvenile idiopathic arthritis

In the past two decades, the treatment of juvenile idiopathic arthritis (JIA) has evolved markedly, owing to the availability of a growing number of novel, potent and relatively safe therapeutic agents and the shift of management strategies towards early achievement of disease remission. However, JIA encompasses a heterogeneous group of diseases that require distinct treatment approaches. Furthermore, some old drugs, such as methotrexate, sulfasalazine and intraarticular glucocorticoids, still maintain an important therapeutic role. In the past 5 years, information on the efficacy and safety of drug therapies for JIA has been further enriched through the accomplishment of several randomized controlled trials of newer biologic and synthetic targeted DMARDs. In addition, a more rational therapeutic approach has been fostered by the promulgation of therapeutic recommendations and guidelines. A multinational collaborative effort has led to the development of the recommendations for the treat-to-target strategy in JIA. There is currently increasing interest in establishing the optimal time and modality for discontinuation of treatment in children with JIA who achieve sustained clinical remission. The aim of this Review is to summarize the current evidence and discuss the therapeutic approaches to the management of non-systemic phenotypes of JIA, including oligoarthritis, polyarthritis, enthesitis-related arthritis and psoriatic arthritis.

[Spondyloarthritis in childhood and adulthood]

Axial spondylarthritis in adulthood (SpAA) is frequently initially manifested as a sacroiliitis, whereas this not true for enthesitis-related arthritis (EAA), which begins in childhood and adolescence. Classically, EAA begins with peripheral arthritis and only a part transitions into a juvenile SpA (jSpA) or SpAA. The criteria used for classification of SpAA and EAA are currently being validated and revised. For the first time imaging is included for EAA. For both diseases nonsteroidal anti-inflammatory drugs (NSAID) are initially used therapeutically, followed by biologicals or synthetic targeted disease-modifying drugs in refractory courses. Steroids should be avoided in long-term treatment. For optimal transition and further care in adulthood, a close cooperation between internistic and pediatric rheumatologists is necessary.

Advances in Juvenile Spondyloarthritis

PURPOSE

To provide an overview of recent studies on pathogenesis, diagnosis, and management of juvenile spondyloarthritis (JSpA).

RECENT FINDINGS

Recent studies show differences in gut microbiome in patients with JSpA in comparison to healthy controls. There is increased recognition of the impact of the innate immune system on disease pathology. Normative reference on MRI of sacroiliac (SI) joints in children is now available. However, there is significant variability in interpretation of MRI of SI joints in children and a need for standardization. NSAIDs, physical therapy, and Tumor Necrosis Factor Inhibitors (TNFi) remain the mainstay of management for patients with JIA who have polyarthritis, sacroiliitis, and/or enthesitis as per recent ACR guidelines. Newer therapeutic options beyond TNFi are needed to manage patients who fail TNFi. This review highlights some of the recent advances in our knowledge of JSpA pathophysiology, diagnosis, and treatment. It also identifies areas in need of further research and standardization to improve our understanding and outcomes in JSpA.