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Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. The International League of Associations for Rheumatology (ILAR) has defined JIA as "arthritis of unknown etiology persisting for ≥6 wk with an onset at <16 y of age, after excluding other causes of joint inflammation". Synovial inflammation is the result of a complex interplay of aberrant immune systems (both adaptive and innate) in a genetically susceptible individual, with possible external stimuli/triggers. Diagnosis of JIA essentially remains clinical, and laboratory investigations usually help to assess the severity of disease activity. Few investigations like antinuclear antibodies (ANA), human leukocyte antigen (HLA)-B27, and rheumatoid factor (RF) help to categorize or prognosticate a child with JIA. Timely use of effective therapeutic interventions including biological has shown good long-term outcomes of JIA.
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Affiliation(s)
- Murugan Sudhakar
- Pediatric Rheumatology Division, Department of Pediatrics, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Sathish Kumar
- Pediatric Rheumatology Division, Department of Pediatrics, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
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Juvenile Idiopathic Arthritis, Uveitis and Multiple Sclerosis: Description of Two Patients and Literature Review. Biomedicines 2022; 10:biomedicines10082041. [PMID: 36009588 PMCID: PMC9405697 DOI: 10.3390/biomedicines10082041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood, while multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by remission and exacerbation phases. An association between MS and rheumatologic diseases, in particular rheumatoid arthritis, has been described and numerous studies acknowledge anti-TNF-α drugs as MS triggers. Conversely, the association between MS and JIA has been reported merely in five cases in the literature. We describe two cases of adult patients with longstanding JIA and JIA-associated uveitis, who developed MS. The first patient was on methotrexate and adalimumab when she developed dizziness and nausea. Characteristic MRI lesions and oligoclonal bands in cerebrospinal fluid led to MS diagnosis. Adalimumab was discontinued, and she was treated with three pulses of intravenous methylprednisolone. After a few months, rituximab was started. The second patient had been treated with anti-TNF-α and then switched to abatacept. She complained of unilateral arm and facial paraesthesias; brain MRI showed characteristic lesions, and MS was diagnosed. Three pulses of intravenous methylprednisolone were administered; neurological disease remained stable, and abatacept was reintroduced. Further studies are warranted to define if there is an association between JIA and MS, if MS represents JIA comorbidity or if anti-TNF-α underpins MS development.
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Improving protocols for whole-body magnetic resonance imaging: oncological and inflammatory applications. Pediatr Radiol 2022:10.1007/s00247-022-05478-5. [PMID: 35982340 DOI: 10.1007/s00247-022-05478-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/16/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
Whole-body MRI is increasingly used in the evaluation of a range of oncological and non-oncological diseases in infants, children and adolescents. Technical innovation in MRI scanners, coils and sequences have enabled whole-body MRI to be performed more rapidly, offering large field-of-view imaging suitable for multifocal and multisystem disease processes in a clinically useful timeframe. Together with a lack of ionizing radiation, this makes whole-body MRI especially attractive in the pediatric population. Indications include lesion detection in cancer predisposition syndrome surveillance and in the workup of children with known malignancies, and diagnosis and monitoring of a host of infectious and non-infectious inflammatory conditions. Choosing which patients are most likely to benefit from this technology is crucial, but so is adjusting protocols to the patient and disease to optimize lesion detection. The focus of this review is on protocols and the elements impacting image acquisition in pediatric whole-body MRI. We consider the practical aspects, from scanner and coil selection to patient positioning, single-center generic and indication-specific protocols with technical parameters, motion reduction strategies and post-processing. When optimized, collectively these lead to better standardization of whole-body MRI, and when married to systematic analysis and interpretation, they can improve diagnostic accuracy.
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The performances of the ILAR, ASAS, and PRINTO classification criteria in ERA patients: a comparison study. Clin Rheumatol 2022; 41:1785-1792. [DOI: 10.1007/s10067-022-06080-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/03/2022] [Accepted: 01/23/2022] [Indexed: 01/17/2023]
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Oliver M, Simard JF, Lee T, Gerstbacher D, Sandborg C. Determinants of Tumor Necrosis Factor Inhibitor Use in Juvenile Spondyloarthropathy and Impact on Clinical Disease Outcomes. ACR Open Rheumatol 2021; 4:19-26. [PMID: 34647693 PMCID: PMC8754014 DOI: 10.1002/acr2.11353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/14/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Objective The objectives of this study were to characterize the reasons for tumor necrosis factor inhibitor (TNFi) initiation in patients with juvenile spondyloarthropathy (JSpA) and identify clinical correlates and to assess the effect of TNFi therapy on JSpA disease activity. Methods We conducted a retrospective cohort study of 86 patients with JSpA with first‐time use of a TNFi over a 7‐year period at Stanford Children's Health. We assessed the physician's reason for TNFi initiation, disease activity at 6 months, and clinical disease status at 12 months following TNFi start. Changes in active joint count, enthesitis count, and pain were measured. Demographics, physician reasons for TNFi initiation, and clinical characteristics were summarized. Results The mean age at JSpA diagnosis was 12.4 years (SD 4.0 years), and the mean time from diagnosis to TNFi initiation was 1.6 years (SD 2.3 years). The most common reason for initiating a TNFi was active disease on physical examination (61%). At 6 months post TNFi initiation, patients on average had three fewer active joints and one fewer active enthesitis point. Patient‐reported pain improved from moderate/severe to mild. After 12 months, 54% of patients had active disease. Conclusion The physician's decision to initiate a TNFi relied mostly on physical examination findings. Despite improvement in arthritis, enthesitis, and patient‐reported pain at 6 months post TNFi initiation, the majority of the patients still had active disease after 1 year of therapy.
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Tits A, Plougonven E, Blouin S, Hartmann MA, Kaux JF, Drion P, Fernandez J, van Lenthe GH, Ruffoni D. Local anisotropy in mineralized fibrocartilage and subchondral bone beneath the tendon-bone interface. Sci Rep 2021; 11:16534. [PMID: 34400706 PMCID: PMC8367976 DOI: 10.1038/s41598-021-95917-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/02/2021] [Indexed: 12/19/2022] Open
Abstract
The enthesis allows the insertion of tendon into bone thanks to several remarkable strategies. This complex and clinically relevant location often features a thin layer of fibrocartilage sandwiched between tendon and bone to cope with a highly heterogeneous mechanical environment. The main purpose of this study was to investigate whether mineralized fibrocartilage and bone close to the enthesis show distinctive three-dimensional microstructural features, possibly to enable load transfer from tendon to bone. As a model, the Achilles tendon-calcaneus bone system of adult rats was investigated with histology, backscattered electron imaging and micro-computed tomography. The microstructural porosity of bone and mineralized fibrocartilage in different locations including enthesis fibrocartilage, periosteal fibrocartilage and bone away from the enthesis was characterized. We showed that calcaneus bone presents a dedicated protrusion of low porosity where the tendon inserts. A spatially resolved analysis of the trabecular network suggests that such protrusion may promote force flow from the tendon to the plantar ligament, while partially relieving the trabecular bone from such a task. Focusing on the tuberosity, highly specific microstructural aspects were highlighted. Firstly, the interface between mineralized and unmineralized fibrocartilage showed the highest roughness at the tuberosity, possibly to increase failure resistance of a region carrying large stresses. Secondly, fibrochondrocyte lacunae inside mineralized fibrocartilage, in analogy with osteocyte lacunae in bone, had a predominant alignment at the enthesis and a rather random organization away from it. Finally, the network of subchondral channels inside the tuberosity was highly anisotropic when compared to contiguous regions. This dual anisotropy of subchondral channels and cell lacunae at the insertion may reflect the alignment of the underlying collagen network. Our findings suggest that the microstructure of fibrocartilage may be linked with the loading environment. Future studies should characterize those microstructural aspects in aged and or diseased conditions to elucidate the poorly understood role of bone and fibrocartilage in enthesis-related pathologies.
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Affiliation(s)
- Alexandra Tits
- Mechanics of Biological and Bioinspired Materials Laboratory, Department of Aerospace and Mechanical Engineering, University of Liège, Quartier Polytech 1, Allée de la Découverte 9, 4000, Liège, Belgium
| | - Erwan Plougonven
- Chemical Engineering Department, University of Liège, Liège, Belgium
| | - Stéphane Blouin
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Markus A Hartmann
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Jean-François Kaux
- Department of Physical Medicine and Sports Traumatology, University of Liège and University Hospital of Liège, Liège, Belgium
| | - Pierre Drion
- Experimental Surgery Unit, GIGA and Credec, University of Liege, Liege, Belgium
| | - Justin Fernandez
- Auckland Bioengineering Institute and Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | | | - Davide Ruffoni
- Mechanics of Biological and Bioinspired Materials Laboratory, Department of Aerospace and Mechanical Engineering, University of Liège, Quartier Polytech 1, Allée de la Découverte 9, 4000, Liège, Belgium.
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Pagnini I, Scavone M, Maccora I, Mastrolia MV, Marrani E, Bertini F, Lamot L, Simonini G. The Development of Extra-Articular Manifestations in Children With Enthesitis-Related Arthritis: Natural Course or Different Disease Entity? Front Med (Lausanne) 2021; 8:667305. [PMID: 34055840 PMCID: PMC8155293 DOI: 10.3389/fmed.2021.667305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/19/2021] [Indexed: 01/12/2023] Open
Abstract
Introduction: Enthesitis-related Arthritis (ERA) is a specific category of juvenile idiopathic arthritis (JIA) characterized by axial and/or peripheral arthritis, and enthesitis, although other different extra-articular manifestations may encompass its clinical spectrum. Materials and Methods: In order to examine if ERA-JIA with extra-articular involvement may represent a different entity from ERA without extra-articular involvement, we performed a retrospective, observational, monocentric study, in a cohort of ERA patients followed between 2001 and September 2020 at the Pediatric Rheumatology Unit of Meyer Children Hospital of Florence. We analyzed the demographic, clinical, laboratory and imaging data at the disease onset, as well as after 3, 6, and 12 months follow up. Results: We have enrolled 53 patients, 33 males. At the time of diagnosis, average age was 10.9 years, 53 patients had active arthritis and 25 active enthesitis. The middle foot involvement was present in 20 patients. Twenty-five children achieved clinical remission on medication. Extra-articular manifestations were observed in 14 patients, of whom 3 had inflammatory bowel disease, 5 uveitis, one uveitis associated with Crohn disease, 4 SAPHO syndrome, one celiac disease. The cohort was stratified according to the presence/absence of extra-articular manifestations. It was observed that middle foot involvement was more frequent in patients with no extra-articular manifestations (18/39 vs. 2/14; χ2 = 4.45, p = 0.05). Additionally, patients presenting extra-articular manifestation needed more frequently (12/14 vs. 21/39, χ2= 4.45, p = 0.05), and preciously (months: 3.7 ± 5.4 vs. 16.7 ± 26.5, p = 0.02), treatment with biologic agents. Finally, these patients achieved belatedly (months: 31.6 ± 32.3 vs. 22.9 ± 18.3, p = 0.01) and less frequently (3/14 vs. 22/39; χ2= 5.50, p = 0.03) the clinical remission on medication. Eventually, extra-articular involvement inversely correlated with the middle-foot arthritis (ρs −0.29, p = 0.03), the chance to achieve remission on medication (ρs −0.31 e p = 0.02), as well as the chance to keep overall remission, with and without medication (ρs −0.28, p = 0.04). Conclusion: In our cohort, children diagnosed with ERA-JIA at the onset of disease and then developed extra-articular manifestations show the absence of middle foot involvement and worse prognosis with an early need for the use of biologic agents, and overall low chance to achieve remission.
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Affiliation(s)
- Ilaria Pagnini
- Rheumatology Unit, Meyer Children Hospital of Florence, University of Florence, Florence, Italy
| | - Mariangela Scavone
- Rheumatology Unit, Meyer Children Hospital of Florence, University of Florence, Florence, Italy
| | - Ilaria Maccora
- Rheumatology Unit, Meyer Children Hospital of Florence, University of Florence, Florence, Italy
| | | | - Edoardo Marrani
- Rheumatology Unit, Meyer Children Hospital of Florence, University of Florence, Florence, Italy
| | - Federico Bertini
- Radiology Unit, Meyer Children Hospital of Florence, Florence, Italy
| | - Lovro Lamot
- Department of Pediatrics, School of Medicine, University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Gabriele Simonini
- Rheumatology Unit, Meyer Children Hospital of Florence, University of Florence, Florence, Italy
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Chen JL, Abiri P, Tsui E. Recent advances in the treatment of juvenile idiopathic arthritis-associated uveitis. Ther Adv Ophthalmol 2021; 13:2515841420984572. [PMID: 33681703 PMCID: PMC7897841 DOI: 10.1177/2515841420984572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/04/2020] [Indexed: 12/14/2022] Open
Abstract
Juvenile idiopathic arthritis-associated uveitis has an estimated prevalence of 10-20% in patients with juvenile idiopathic arthritis, making it the most common cause of chronic anterior uveitis in children. Prompt treatment is important to prevent development of ocular complications and permanent vision loss. In this review, we will discuss the use of immunosuppression in treatment of juvenile idiopathic arthritis-associated uveitis. This will include the use of conventional immunosuppressants, such as methotrexate, biologic anti-tumor necrosis factor agents, such as adalimumab, as well as other anti-tumor necrosis factor agents, including infliximab and golimumab. In addition, we will discuss medications currently in clinical trials or under consideration for juvenile idiopathic arthritis-associated uveitis, including interleukin-6 inhibitors (tocilizumab) and Janus kinase inhibitors (tofacitinib, baricitinib).
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Affiliation(s)
- Judy L Chen
- Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Parinaz Abiri
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Edmund Tsui
- Assistant Professor of Ophthalmology, Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, 200 Stein Plaza, Los Angeles, CA 90095-7003, USA
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Tirelli F, Xiao R, Brandon TG, Burnham JM, Chang JC, Weiss PF. Determinants of disease activity change over time in Enthesitis related arthritis: effect of structured outcome monitoring and clinical decision support. Pediatr Rheumatol Online J 2020; 18:79. [PMID: 33059694 PMCID: PMC7558695 DOI: 10.1186/s12969-020-00472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to test if standardized point-of-care outcome monitoring and clinical decision support (CDS), as compared to standard care, improves disease activity and patient-reported pain in children with enthesitis-related arthritis (ERA). METHODS This was a retrospective cohort study of outcomes of children with ERA after phased implementation of I) standardized outcome monitoring with CDS for polyarticular JIA, and II) CDS for ERA, compared to a pre-intervention group of historical controls. We used multivariable mixed-effects models for repeated measures to test whether implementation phase or other disease characteristics were associated with change over time in disease activity, as measured by the clinical juvenile arthritis disease activity score (cJADAS), and pain. RESULTS One hundred fifty-two ERA patients (41% incident cases) were included with a median age of 14.9 years. Implementation of standardized outcome monitoring or ERA-specific CDS did not result in significant differences in cJADAS or pain over time compared to the pre-intervention cohort. Higher cJADAS at the index visit, pain and more tender entheses were significantly associated with higher cJADAS scores over time (all p < 0.01), while biologic use was associated with lower cJADAS (p = 0.02). Regardless of intervention period, incident ERA cases had a greater rate of cJADAS improvement over time compared to prevalent cases (p < 0.01), but pain persisted over time among both incident and prevalent cases. CONCLUSIONS There was no significant effect of point-of-care outcome monitoring or CDS interventions on disease activity or pain over time in children with ERA in this single center study. Future efforts to improve disease outcomes using standardized outcome monitoring and CDS will need to consider the importance of addressing pain as a target in addition to spondyloarthritis-specific disease activity metrics.
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Affiliation(s)
- Francesca Tirelli
- grid.5608.b0000 0004 1757 3470Department of Pediatrics, Rheumatology Unit, Anna Meyer Children’s Hospital and Department of Women’s and Children’s Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Rui Xiao
- grid.25879.310000 0004 1936 8972Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Timothy G. Brandon
- grid.239552.a0000 0001 0680 8770Department of Pediatrics, Division of Rheumatology at the Children’s Hospital of Philadelphia, Wood Bldg 1st foor, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Jon M. Burnham
- grid.25879.310000 0004 1936 8972Department of Pediatrics, Division of Rheumatology at the Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Wood Bldg 1st foor, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Joyce C. Chang
- grid.25879.310000 0004 1936 8972Department of Pediatrics, Division of Rheumatology at the Children’s Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Wood Bldg 1st foor, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Pamela F. Weiss
- grid.25879.310000 0004 1936 8972Department of Pediatrics, Division of Rheumatology at the Children’s Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Wood Bldg 1st foor, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA ,grid.239552.a0000 0001 0680 8770The Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 11121, Philadelphia, PA 19104 USA
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Bridgewood C, Sharif K, Sherlock J, Watad A, McGonagle D. Interleukin-23 pathway at the enthesis: The emerging story of enthesitis in spondyloarthropathy. Immunol Rev 2020; 294:27-47. [PMID: 31957051 DOI: 10.1111/imr.12840] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/11/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022]
Abstract
The inflammatory disorders collectively termed the seronegative spondyloarthropathies (SpA) include ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis, the arthritis associated with inflammatory bowel disease including Crohn's disease and ulcerative colitis, the arthritis related to anterior uveitis, and finally, somewhat controversially Behcet's disease. All of these diseases are associated with SNPs in the IL-23R or the interleukin-23 (IL-23) cytokine itself and related downstream signaling JAK pathway genes and the interleukin-17 (IL-17) pathway. In rheumatoid arthritis, the target of the immune response is the synovium but the SpA disorders target the tendon, ligament, and joint capsule skeletal anchorage points that are termed entheses. The discovery that IL-23R-expressing cells were ensconced in healthy murine enthesis, and other extraskeletal anchorage points including the aortic root and the ciliary body of the eye and that systemic overexpression of IL-23 resulted in a severe experimental SpA, confirmed a fundamentally different immunobiology to rheumatoid arthritis. Recently, IL-23R-expressing myeloid cells and various innate and adaptive T cells that produce IL-17 family cytokines have also been described in the human enthesis. Blockade of IL-23 pathway with either anti-p40 or anti-p19 subunits has resulted in some spectacular therapeutic successes in psoriasis and PsA including improvement in enthesitis in the peripheral skeleton but has failed to demonstrate efficacy in AS that is largely a spinal polyenthesitis. Herein, we discuss the known biology of IL-23 at the human enthesis and highlight the remarkable emerging story of this unique skeletal tissue.
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Affiliation(s)
- Charlie Bridgewood
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Kassem Sharif
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Department of Medicine "B", Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jonathan Sherlock
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Abdulla Watad
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Department of Medicine "B", Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton, Leeds Teaching Hospital Trust, Leeds, UK
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Bakewell C, Aydin SZ, Ranganath VK, Eder L, Kaeley GS. Imaging Techniques: Options for the Diagnosis and Monitoring of Treatment of Enthesitis in Psoriatic Arthritis. J Rheumatol 2019; 47:973-982. [PMID: 31676700 DOI: 10.3899/jrheum.190512] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 02/08/2023]
Abstract
Psoriatic arthritis (PsA) affects up to 30% of patients with psoriasis and may include musculoskeletal manifestations such as enthesitis. Enthesitis is associated with joint damage, and early detection and treatment are essential to management of the disease. Traditionally assessed by clinical examination and conventional radiography, entheseal inflammation can now be more accurately assessed earlier in the disease using techniques such as ultrasound, magnetic resonance imaging, computed tomography, and molecular imaging. However, there is little consensus on the optimum definition for diagnosing enthesitis in PsA or on the ideal scoring system for measuring response to treatment. This review aims to summarize the benefits and limitations of different imaging modalities in the assessment of enthesitis. It also proposes that adoption of standardized definitions and validation of scoring systems and imaging techniques in clinical trials will allow the efficacy of new treatment options to be assessed more accurately.
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Affiliation(s)
- Catherine Bakewell
- From the Intermountain Healthcare Medical Group, Salt Lake City, Utah, USA; University of Ottawa, Ottawa, Ontario, Canada; University of California, Los Angeles (UCLA), California, USA; Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; University of Florida College of Medicine, Jacksonville, Florida, USA. .,C. Bakewell has received consultancy fees from and/or served on speakers bureaus for AbbVie and Novartis Pharmaceuticals Corp. S.Z. Aydin has received honoraria from Novartis. V.K. Ranganath has served on the Data and Safety Monitoring Board for Amgen and has received grants for investigator-initiated studies from Mallinckrodt. L. Eder has received research or educational grants and/or consultancy fees from Novartis. G.S. Kaeley has received consultancy fees from Novartis. .,C. Bakewell, MD, Rheumatologist, Intermountain Healthcare Medical Group Salt Lake Clinic; S.Z. Aydin, MD, Associate Professor in Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; V.K. Ranganath, MD, MS, Health Sciences Associate Clinical Professor, Division of Rheumatology, David Geffen School of Medicine at UCLA; L. Eder, MD, PhD, Assistant Professor of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto; G.S. Kaeley, MBBS, MRCP, RhMSUS, Professor, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine.
| | - Sibel Zehra Aydin
- From the Intermountain Healthcare Medical Group, Salt Lake City, Utah, USA; University of Ottawa, Ottawa, Ontario, Canada; University of California, Los Angeles (UCLA), California, USA; Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; University of Florida College of Medicine, Jacksonville, Florida, USA.,C. Bakewell has received consultancy fees from and/or served on speakers bureaus for AbbVie and Novartis Pharmaceuticals Corp. S.Z. Aydin has received honoraria from Novartis. V.K. Ranganath has served on the Data and Safety Monitoring Board for Amgen and has received grants for investigator-initiated studies from Mallinckrodt. L. Eder has received research or educational grants and/or consultancy fees from Novartis. G.S. Kaeley has received consultancy fees from Novartis.,C. Bakewell, MD, Rheumatologist, Intermountain Healthcare Medical Group Salt Lake Clinic; S.Z. Aydin, MD, Associate Professor in Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; V.K. Ranganath, MD, MS, Health Sciences Associate Clinical Professor, Division of Rheumatology, David Geffen School of Medicine at UCLA; L. Eder, MD, PhD, Assistant Professor of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto; G.S. Kaeley, MBBS, MRCP, RhMSUS, Professor, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine
| | - Veena K Ranganath
- From the Intermountain Healthcare Medical Group, Salt Lake City, Utah, USA; University of Ottawa, Ottawa, Ontario, Canada; University of California, Los Angeles (UCLA), California, USA; Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; University of Florida College of Medicine, Jacksonville, Florida, USA.,C. Bakewell has received consultancy fees from and/or served on speakers bureaus for AbbVie and Novartis Pharmaceuticals Corp. S.Z. Aydin has received honoraria from Novartis. V.K. Ranganath has served on the Data and Safety Monitoring Board for Amgen and has received grants for investigator-initiated studies from Mallinckrodt. L. Eder has received research or educational grants and/or consultancy fees from Novartis. G.S. Kaeley has received consultancy fees from Novartis.,C. Bakewell, MD, Rheumatologist, Intermountain Healthcare Medical Group Salt Lake Clinic; S.Z. Aydin, MD, Associate Professor in Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; V.K. Ranganath, MD, MS, Health Sciences Associate Clinical Professor, Division of Rheumatology, David Geffen School of Medicine at UCLA; L. Eder, MD, PhD, Assistant Professor of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto; G.S. Kaeley, MBBS, MRCP, RhMSUS, Professor, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine
| | - Lihi Eder
- From the Intermountain Healthcare Medical Group, Salt Lake City, Utah, USA; University of Ottawa, Ottawa, Ontario, Canada; University of California, Los Angeles (UCLA), California, USA; Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; University of Florida College of Medicine, Jacksonville, Florida, USA.,C. Bakewell has received consultancy fees from and/or served on speakers bureaus for AbbVie and Novartis Pharmaceuticals Corp. S.Z. Aydin has received honoraria from Novartis. V.K. Ranganath has served on the Data and Safety Monitoring Board for Amgen and has received grants for investigator-initiated studies from Mallinckrodt. L. Eder has received research or educational grants and/or consultancy fees from Novartis. G.S. Kaeley has received consultancy fees from Novartis.,C. Bakewell, MD, Rheumatologist, Intermountain Healthcare Medical Group Salt Lake Clinic; S.Z. Aydin, MD, Associate Professor in Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; V.K. Ranganath, MD, MS, Health Sciences Associate Clinical Professor, Division of Rheumatology, David Geffen School of Medicine at UCLA; L. Eder, MD, PhD, Assistant Professor of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto; G.S. Kaeley, MBBS, MRCP, RhMSUS, Professor, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine
| | - Gurjit S Kaeley
- From the Intermountain Healthcare Medical Group, Salt Lake City, Utah, USA; University of Ottawa, Ottawa, Ontario, Canada; University of California, Los Angeles (UCLA), California, USA; Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; University of Florida College of Medicine, Jacksonville, Florida, USA.,C. Bakewell has received consultancy fees from and/or served on speakers bureaus for AbbVie and Novartis Pharmaceuticals Corp. S.Z. Aydin has received honoraria from Novartis. V.K. Ranganath has served on the Data and Safety Monitoring Board for Amgen and has received grants for investigator-initiated studies from Mallinckrodt. L. Eder has received research or educational grants and/or consultancy fees from Novartis. G.S. Kaeley has received consultancy fees from Novartis.,C. Bakewell, MD, Rheumatologist, Intermountain Healthcare Medical Group Salt Lake Clinic; S.Z. Aydin, MD, Associate Professor in Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; V.K. Ranganath, MD, MS, Health Sciences Associate Clinical Professor, Division of Rheumatology, David Geffen School of Medicine at UCLA; L. Eder, MD, PhD, Assistant Professor of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto; G.S. Kaeley, MBBS, MRCP, RhMSUS, Professor, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine
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Kısaarslan AP, Sözeri B, Gündüz Z, Zararsız G, Poyrazoğlu H, Düşünsel R. Evaluation of factors affecting the duration of disease-modifying anti-rheumatic drugs application in patients with enthesitis-related arthritis. Eur J Rheumatol 2019; 6:130-135. [PMID: 31070580 DOI: 10.5152/eurjrheum.2019.18180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/05/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Treatments for enthesitis-related arthritis (ERA) consist of a mono- or combination therapy with non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs (DMARDs), and biological agents, and they are primarily based on adult studies and studies on other forms of juvenile idiopathic arthritis, depending on whether there is axial or peripheral involvement. We use DMARDs frequently in our daily practice, even in patients with axial involvement. The main reason for this is that the health insurance system in Turkey does not allow the use of Tumor Negrosis Factor (TNF) blockers as the first line of treatment. The aim of this study is to evaluate the factors affecting the duration of DMARDs application in patients with ERA. METHODS Fifty-two patients with ERA were accepted in this retrospective cohort study. These patients did not have an inflammatory bowel disease, reactive arthritis or undifferentiated arthritis, psoriasis, and familial Mediterranean fever. Demographic characteristics, medical history, the initial and follow-up physical examination, initial Juvenile Spondyloarthritis Disease Activity Index (JSpADA), initial laboratory tests, radiographic tests, Juvenile Arthritis Damage Index-articulary (JADI-A) and extra-articulary (JADI-E) on the last admission, and data on medical treatments were recorded from the registered data. The univariate Cox proportional hazards regression analyses was used to determine factors affecting the non-response time of ERA patients to DMARDs before the biological treatment was started. RESULTS Twenty-seven patients (52%) achieved remission with DMARDs, while 25 (48%) patients did not. The age at diagnosis (HR=1.12; p=0.247); gender (HR=2.53; p=0.210); family history of ankylosing spondylitis (HR=1.17; p=0.730); inflammatory back pain (HR=0.57; p=0.175); the shoulder (HR=0.75 p=0.706), hip (HR=0.45; p=0.129), and small-joint involvement (HR=1.53; p=0.439); sacroiliitis with physical examination (HR=0.90; p=0.814) and magnetic resonance imaging (MRI) (HR=2.84; p=0.110); enthesitis (HR=0.83; p=0.670); presence of uveitis (HR=2.04; p=0.342); presence of HLA-B27 (HR=1.39; p=0.524); initial high acute phase reactants levels(HR=1.89; p=0.183); initial JSpADA score (HR=0.98; p=0.944); and last JADI-A (HR=1.41; p=0.060) score did not affect the duration of DMARDs treatment before switching to biological treatments. CONCLUSION In our study, the absence of factors affecting the duration of DMARDs application in patients with ERA showed that DMARDs may still be applied as the first line of treatment.
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Affiliation(s)
- Ayşenur Paç Kısaarslan
- Department of Pediatric Rheumatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Zübeyde Gündüz
- Department of Pediatric Rheumatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Gökmen Zararsız
- Department of Biostatistics, Erciyes University School of Medicine, Kayseri, Turkey
| | - Hakan Poyrazoğlu
- Department of Pediatric Rheumatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ruhan Düşünsel
- Department of Pediatric Rheumatology, Erciyes University School of Medicine, Kayseri, Turkey
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13
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Panwar J, Tse SML, Lim L, Tolend MA, Radhakrishnan S, Salman M, Moineddin R, Doria AS, Stimec J. Spondyloarthritis Research Consortium of Canada Scoring System for Sacroiliitis in Juvenile Spondyloarthritis/Enthesitis-related Arthritis: A Reliability, Validity, and Responsiveness Study. J Rheumatol 2019; 46:636-644. [PMID: 30709956 DOI: 10.3899/jrheum.180222] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Intra- and interreader reliability, construct validity, and responsiveness of the Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) scoring system were investigated for scoring sacroiliitis in patients with juvenile spondyloarthritis (JSpA)/enthesitis-related arthritis (ERA) who have received biologic and/or nonbiologic treatment. METHODS Ninety whole-body MRI examinations with dedicated oblique coronal planes of the sacroiliac joints in 46 patients were independently reviewed and scored by 2 pediatric musculoskeletal radiologists, blinded to clinical details, using the SPARCC system. Intra- and interreader reliability was assessed by intraclass correlation coefficients (ICC). Construct validity testing was done by (1) correlating the SPARCC MRI scores of sacroiliitis with clinical disease activity indicators (cross-sectional validity), and (2) correlating the change in the MRI score with the change in clinical indicators before and after treatment (longitudinal validity). Responsiveness of the MRI and clinical indicators was also evaluated, grouped by biologic and nonbiologic treatment. RESULTS When applied in children with JSpA/ERA, the SPARCC showed almost perfect intra- and interreader reliability (ICC 0.79-1.00). There was poor cross-sectional and longitudinal correlation between clinical assessment indicators and MRI scoring. SPARCC scores showed higher responsiveness to treatment-related change than most clinical outcome measures. Three clinical outcome measures correlated longitudinally with SPARCC score in nonbiologic treatment: active joint count (r = 0.72, p < 0.001), FABER (Flexion, Abduction, External Rotation) test (r = 0.58, p = 0.012), and physician's global assessment (r = 0.61, p = 0.034). CONCLUSION The SPARCC MRI scoring system is a reliable tool with relatively higher responsiveness than clinical indicators and is suitable for objective quantification of sacroiliitis when applied to pediatric patients with JSpA/ERA.
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Affiliation(s)
- Jyoti Panwar
- From the Joint Department of Medical Imaging, University Health Network, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta, Edmonton, Alberta; Kanchi Kamakoti CHILDS Trust Hospital, Chennai; Department of Radiology, Christian Medical College, Vellore, India; Makassed Hospital, Jerusalem, Israel; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. .,J. Panwar, MD, FRCR, Joint Department of Medical Imaging, University Health Network, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College; S.M. Tse, MD, Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto; L. Lim, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta; M.A. Tolend, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; S. Radhakrishnan, MD, Kanchi Kamakoti CHILDS Trust Hospital; M. Salman, MD, Makassed Hospital; R. Moineddin, PhD, Department of Family and Community Medicine, University of Toronto; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; J. Stimec, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto.
| | - Shirley M L Tse
- From the Joint Department of Medical Imaging, University Health Network, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta, Edmonton, Alberta; Kanchi Kamakoti CHILDS Trust Hospital, Chennai; Department of Radiology, Christian Medical College, Vellore, India; Makassed Hospital, Jerusalem, Israel; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,J. Panwar, MD, FRCR, Joint Department of Medical Imaging, University Health Network, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College; S.M. Tse, MD, Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto; L. Lim, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta; M.A. Tolend, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; S. Radhakrishnan, MD, Kanchi Kamakoti CHILDS Trust Hospital; M. Salman, MD, Makassed Hospital; R. Moineddin, PhD, Department of Family and Community Medicine, University of Toronto; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; J. Stimec, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto
| | - Lillian Lim
- From the Joint Department of Medical Imaging, University Health Network, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta, Edmonton, Alberta; Kanchi Kamakoti CHILDS Trust Hospital, Chennai; Department of Radiology, Christian Medical College, Vellore, India; Makassed Hospital, Jerusalem, Israel; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,J. Panwar, MD, FRCR, Joint Department of Medical Imaging, University Health Network, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College; S.M. Tse, MD, Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto; L. Lim, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta; M.A. Tolend, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; S. Radhakrishnan, MD, Kanchi Kamakoti CHILDS Trust Hospital; M. Salman, MD, Makassed Hospital; R. Moineddin, PhD, Department of Family and Community Medicine, University of Toronto; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; J. Stimec, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto
| | - Mirkamal A Tolend
- From the Joint Department of Medical Imaging, University Health Network, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta, Edmonton, Alberta; Kanchi Kamakoti CHILDS Trust Hospital, Chennai; Department of Radiology, Christian Medical College, Vellore, India; Makassed Hospital, Jerusalem, Israel; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,J. Panwar, MD, FRCR, Joint Department of Medical Imaging, University Health Network, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College; S.M. Tse, MD, Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto; L. Lim, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta; M.A. Tolend, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; S. Radhakrishnan, MD, Kanchi Kamakoti CHILDS Trust Hospital; M. Salman, MD, Makassed Hospital; R. Moineddin, PhD, Department of Family and Community Medicine, University of Toronto; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; J. Stimec, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto
| | - Shilpa Radhakrishnan
- From the Joint Department of Medical Imaging, University Health Network, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta, Edmonton, Alberta; Kanchi Kamakoti CHILDS Trust Hospital, Chennai; Department of Radiology, Christian Medical College, Vellore, India; Makassed Hospital, Jerusalem, Israel; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,J. Panwar, MD, FRCR, Joint Department of Medical Imaging, University Health Network, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College; S.M. Tse, MD, Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto; L. Lim, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta; M.A. Tolend, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; S. Radhakrishnan, MD, Kanchi Kamakoti CHILDS Trust Hospital; M. Salman, MD, Makassed Hospital; R. Moineddin, PhD, Department of Family and Community Medicine, University of Toronto; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; J. Stimec, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto
| | - Muayad Salman
- From the Joint Department of Medical Imaging, University Health Network, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta, Edmonton, Alberta; Kanchi Kamakoti CHILDS Trust Hospital, Chennai; Department of Radiology, Christian Medical College, Vellore, India; Makassed Hospital, Jerusalem, Israel; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,J. Panwar, MD, FRCR, Joint Department of Medical Imaging, University Health Network, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College; S.M. Tse, MD, Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto; L. Lim, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta; M.A. Tolend, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; S. Radhakrishnan, MD, Kanchi Kamakoti CHILDS Trust Hospital; M. Salman, MD, Makassed Hospital; R. Moineddin, PhD, Department of Family and Community Medicine, University of Toronto; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; J. Stimec, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto
| | - Rahim Moineddin
- From the Joint Department of Medical Imaging, University Health Network, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta, Edmonton, Alberta; Kanchi Kamakoti CHILDS Trust Hospital, Chennai; Department of Radiology, Christian Medical College, Vellore, India; Makassed Hospital, Jerusalem, Israel; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,J. Panwar, MD, FRCR, Joint Department of Medical Imaging, University Health Network, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College; S.M. Tse, MD, Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto; L. Lim, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta; M.A. Tolend, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; S. Radhakrishnan, MD, Kanchi Kamakoti CHILDS Trust Hospital; M. Salman, MD, Makassed Hospital; R. Moineddin, PhD, Department of Family and Community Medicine, University of Toronto; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; J. Stimec, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto
| | - Andrea S Doria
- From the Joint Department of Medical Imaging, University Health Network, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta, Edmonton, Alberta; Kanchi Kamakoti CHILDS Trust Hospital, Chennai; Department of Radiology, Christian Medical College, Vellore, India; Makassed Hospital, Jerusalem, Israel; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,J. Panwar, MD, FRCR, Joint Department of Medical Imaging, University Health Network, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College; S.M. Tse, MD, Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto; L. Lim, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta; M.A. Tolend, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; S. Radhakrishnan, MD, Kanchi Kamakoti CHILDS Trust Hospital; M. Salman, MD, Makassed Hospital; R. Moineddin, PhD, Department of Family and Community Medicine, University of Toronto; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; J. Stimec, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto
| | - Jennifer Stimec
- From the Joint Department of Medical Imaging, University Health Network, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta, Edmonton, Alberta; Kanchi Kamakoti CHILDS Trust Hospital, Chennai; Department of Radiology, Christian Medical College, Vellore, India; Makassed Hospital, Jerusalem, Israel; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,J. Panwar, MD, FRCR, Joint Department of Medical Imaging, University Health Network, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College; S.M. Tse, MD, Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto; L. Lim, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta; M.A. Tolend, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; S. Radhakrishnan, MD, Kanchi Kamakoti CHILDS Trust Hospital; M. Salman, MD, Makassed Hospital; R. Moineddin, PhD, Department of Family and Community Medicine, University of Toronto; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; J. Stimec, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto
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Goirand M, Breton S, Chevallier F, Duong NP, Uettwiller F, Melki I, Mouy R, Wouters C, Bader-Meunier B, Job-Deslandre C, Quartier P. Clinical features of children with enthesitis-related juvenile idiopathic arthritis / juvenile spondyloarthritis followed in a French tertiary care pediatric rheumatology centre. Pediatr Rheumatol Online J 2018; 16:21. [PMID: 29609643 PMCID: PMC5879929 DOI: 10.1186/s12969-018-0238-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/13/2018] [Indexed: 12/14/2022] Open
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.
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Affiliation(s)
- Maxime Goirand
- Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l'Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15, Paris, France. .,Paris Descartes University, 12 rue de l'Ecole de Médicine, 75006, Paris, France. .,GOIRAND, CETD et EMASP pédiatrique, Hôpital Robert Debré, 48, Boulevard Serrurier, 75019, Paris, France.
| | - Sylvain Breton
- 0000 0001 2175 4109grid.50550.35Pediatric Radiology Department, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex 15 Paris, France
| | - Frédéric Chevallier
- 0000000121496883grid.11318.3aUFR SMBH Paris 13, 74 rue Marcel Cachin, 93017 Cedex Bobigny, France
| | - Ngoc-Phoi Duong
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,0000 0004 1765 2136grid.414145.1Service de Réanimation Néonatale, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Florence Uettwiller
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,grid.462336.6Imagine Institute, 24 boulevard du Montparnasse, 75015 Paris, France
| | - Isabelle Melki
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,grid.462336.6Imagine Institute, 24 boulevard du Montparnasse, 75015 Paris, France ,0000 0001 2175 4109grid.50550.35General Pediatrics, Infectious Disease, and Internal Medicine Unit, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, 48 boulevard Sérurier, 75019 Paris, France ,0000000121866389grid.7429.8INSERM UMR 1163, Laboratory of Neurogenetics and Neuroinflammation, Paris, France
| | - Richard Mouy
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,grid.462336.6Imagine Institute, 24 boulevard du Montparnasse, 75015 Paris, France
| | - Carine Wouters
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,grid.462336.6Imagine Institute, 24 boulevard du Montparnasse, 75015 Paris, France
| | - Brigitte Bader-Meunier
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,grid.462336.6Imagine Institute, 24 boulevard du Montparnasse, 75015 Paris, France
| | - Chantal Job-Deslandre
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France
| | - Pierre Quartier
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,0000 0001 2188 0914grid.10992.33Paris Descartes University, 12 rue de l’Ecole de Médicine, 75006 Paris, France ,grid.462336.6Imagine Institute, 24 boulevard du Montparnasse, 75015 Paris, France
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Gupta L, Bhattacharya S, Aggarwal A. Tenascin-C, a biomarker of disease activity in early ankylosing spondylitis. Clin Rheumatol 2018; 37:1401-1405. [PMID: 29313272 DOI: 10.1007/s10067-017-3938-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/23/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022]
Abstract
Monocytes of patients with ankylosing spondylitis (AS) over-express toll-like receptor (TLR) 4. Tenascin-C (TNC) is an endogenous TLR4 ligand. Thus, we studied the serum and synovial fluid levels of TNC in AS. TNC was measured in serum of 36 AS patients (ASAS 2010 criteria) and 39 healthy controls by ELISA. Twenty-two patients were followed up after 3 months of standard treatment. Five paired serum-synovial fluid samples were also analyzed. Disease activity was assessed by BASDAI, ASDAS, swollen joint count, ESR, and CRP. All values are in median (IQR). Median age was 30 (20-35) years, and disease duration was 5.5 (1.3-10) years. Thirty-one were male. Twenty-five (69.5%) had peripheral arthritis. Median BASDAI was 5.3 (3.3-6.7). HLA B27 was positive in 34 (94.5%) cases. Median serum tenascin C levels were higher in AS [578.5 ng/ml] as compared to healthy controls [32.88 ng/ml, p < 0.0001]. Serum tenascin C levels correlated with ASDAS ESR [r = 0.367, p = 0.028] and ESR [r = 0.39, p = 0.035]. In patients with early disease (duration ≤ 5 years), serum levels had better correlation with ESR [r = 0.59, p = 0.009] and CRP [r = 0.479, p = 0.044]. On ROC analysis for active (PhGA ≥ 6) vs. inactive (PhGA ≤ 4) disease, tenascin-C (AUC = 0.60) performed as well as CRP (AUC = 0.65) and ESR (AUC = 0.73). Synovial fluid levels [11.61 (5.99-176.9) ng/ml] were lower than in serum [627.4 (488.5-779.1) ng/ml, p = 0.008]. Tenascin C fell levels with treatment [n = 11, 630.8 ng/ml to 376.4 ng/ml p = 0.0006] in treatment responders but not in non-responders [n = 11, 562.3 to 445.6, p = 0.33]. Serum TNC levels are raised in AS and may serve as marker of inflammation in early disease.
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Affiliation(s)
- Latika Gupta
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Shruti Bhattacharya
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Amita Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
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Kaeley GS, Eder L, Aydin SZ, Gutierrez M, Bakewell C. Enthesitis: A hallmark of psoriatic arthritis. Semin Arthritis Rheum 2018; 48:35-43. [PMID: 29429762 DOI: 10.1016/j.semarthrit.2017.12.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To describe the growing importance of enthesitis in patients with psoriatic arthritis (PsA) and discuss the advantages and disadvantages of clinical and imaging methods currently used to assess enthesitis. METHODS PubMed literature searches were conducted using the terms psoriatic arthritis, entheses, enthesitis, pathology, imaging, ultrasound, magnetic resonance imaging, clinical, and indices. Articles were deemed relevant if they provided insight into the pathology, monitoring, and/or diagnosis of enthesitis in PsA, or if they discussed clinical or imaging indices used to assess enthesitis. RESULTS Enthesitis is an early manifestation of PsA that is associated with increased disease activity and reduced quality of life. A variety of clinical indices exist to assess enthesitis in PsA; however, the Leeds Enthesitis Index and Maastricht Ankylosing Spondylitis Enthesitis Score index have been the most frequently used indices in recent clinical trials. Limitations of these indices include an inability to discern structural involvement, risk of missing subclinical enthesitis, and lack of sensitivity in detecting enthesitis, especially in patients with central sensitization and/or pain amplification. Such limitations have led to the emergent importance of imaging techniques in the assessment of enthesitis. Although there have been recent advances in magnetic resonance imaging, ultrasound (US) appears to be the preferred method for detecting enthesitis because it allows for accurate assessment of the soft-tissue components of entheses and also for new bone formation. Hypoechogenicity, increased thickness of tendon insertion, calcifications, enthesophytes, erosions, and Doppler activity have been identified as important US characteristics of enthesitis. CONCLUSION Enthesitis is thought to be integrally involved in the pathogenesis of PsA and is associated with worse prognostic outcomes in patients with PsA. A validated US index with entheses that are less confounded by mechanical factors and obesity would be the most effective measure of enthesitis in PsA. As imaging techniques continue to advance, our understanding of enthesitis and its involvement in PsA will also improve.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, 653-1 West 8th St., LRC 2nd Floor L-14, Jacksonville, FL, 32209.
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Sibel Z Aydin
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación, Mexico City, Mexico
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Affiliation(s)
- Youn-Soo Hahn
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
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Inflammatory arthritis mimicking Complex Regional Pain Syndrome (CRPS) in a child: A case report. North Clin Istanb 2017; 3:131-134. [PMID: 28058400 PMCID: PMC5206463 DOI: 10.14744/nci.2015.33043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 10/28/2015] [Indexed: 11/29/2022] Open
Abstract
Joint complaints in childhood are seen frequently and differential diagnosis can be difficult. Juvenile idiopathic arthritis (JIA) is the most common rheumatological disease of childhood. It involves peripheral joint arthritis, chronic synovitis, and extra-articular manifestations. Accurate diagnosis can take a long time and sometimes multiple diagnoses are used while following the patient until a final diagnosis can be reached. Arthritis may be triggered by trauma and confused with other diseases like complex regional pain syndrome (CRPS), in which trauma plays a role in the etiology. In the present case, ankle pain in an 8-year-old girl was misdiagnosed as CRPS.
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Bray TJP, Amies T, Vendhan K, Humphries P, Sen D, Ioannou Y, Hall-Craggs MA. Discordant inflammatory changes in the apophyseal and sacroiliac joints: serial observations in enthesitis-related arthritis. Br J Radiol 2016; 89:20160353. [PMID: 27376529 DOI: 10.1259/bjr.20160353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine the extent to which inflammation of the sacroiliac joints (SIJs) and apophyseal joints (AJs) changes concordantly after treatment in enthesitis-related arthritis (ERA). METHODS A retrospective study was performed with institutional review board approval. 31 young patients with ERA who had been scanned between March 2009 and November 2014 were included. All patients had post-contrast imaging of the SIJs and lumbar spine and short tau inversion-recovery (STIR) images of the SIJs. The severity of sacroiliitis was scored using a modification of an established technique, and inflammation of the AJs was evaluated using a recently described grading system. The changes in SIJ and AJ scores after treatment were classified as either concordant or discordant, and the proportion of scan pairs in these groups was recorded. In addition, the correlation between change in SIJ STIR score (Δnfla) and change in AJ score (ΔAJ) was assessed using Spearman's correlation coefficient. RESULTS Of a total of 43 scan pairs, the changes in inflammation were concordant in 16 scan pairs and discordant in 27 scan pairs. There was no significant correlation between Δnfla and ΔAJ (R = 0.14, p = 0.37). CONCLUSION Inflammatory changes in the SIJs and AJs are often discordant. This may be a reason why patients experience ongoing back pain despite apparent improvement in one or the other site. ADVANCES IN KNOWLEDGE Inflammation may behave differently at different anatomical sites. The SIJs and AJs should both be imaged in patients with ERA with back pain.
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Affiliation(s)
- Timothy J P Bray
- 1 Centre for Medical Imaging, University College London, London, UK
| | - Thomas Amies
- 1 Centre for Medical Imaging, University College London, London, UK
| | | | - Paul Humphries
- 1 Centre for Medical Imaging, University College London, London, UK
| | - Debajit Sen
- 2 Arthritis UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Yiannis Ioannou
- 2 Arthritis UK Centre for Adolescent Rheumatology, University College London, London, UK
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Enthesitis in a 16-Year-Old Boy with M694V Mutation. Case Rep Med 2016; 2016:5869250. [PMID: 28044082 PMCID: PMC5164889 DOI: 10.1155/2016/5869250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/16/2016] [Accepted: 11/22/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. FMF (Familial Mediterranean Fever) is characterized by recurrent attacks of fever and articular pain. Enthesitis is the hallmark of pain in spondyloarthropathy. Literature suggests association of M694V mutation and enthesitis. We report a case of a 16-year-old boy with enthesitis and FMF. Case Presentation. A 16-year-old boy of Turkish origin with a history of FMF presented with localized tenderness of the heel and severe disability. MRI showed an enthesitis of the plantar fascia. Standard treatment of FMF and enthesitis was not successful. After referral to a university hospital and expert opinion of a professor in rheumatology, this enthesitis should be treated as an enthesitis related arthritis. With this treatment, our patient fully recovered 8 months after the onset of the disease symptoms. Conclusion. M694V mutation related enthesitis should be considered in FMF patients with enthesitis. We would suggest treatment for enthesitis related arthritis in similar cases. This is of clinical importance because the treatment is different from treatment of enthesitis or articular pain caused by FMF.
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Guo R, Cao L, Kong X, Liu X, Xue H, Shen L, Li X. Fever as an initial manifestation of enthesitis-related arthritis subtype of juvenile idiopathic arthritis: retrospective study. PLoS One 2015; 10:e0128979. [PMID: 26030261 PMCID: PMC4451976 DOI: 10.1371/journal.pone.0128979] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/04/2015] [Indexed: 01/22/2023] Open
Abstract
Objective We wished to determine the prevalence of fever as one of the first symptoms of the enthesitis-related arthritis (ERA) subtype of juvenile idiopathic arthritis. Also, we wished to ascertain if ERA patients with fever at disease onset differed from those without fever. Methods Consecutive cases of ERA were diagnosed and followed in a retrospective observational study from 1998 to 2013. Information about clinical/laboratory data, medications, magnetic resonance imaging (MRI), and disease activity during the study period was also recorded. Results A total of 146 consecutive ERA patients were assessed. Among them, 52 patients (35.6%) had fever as one of the first symptoms at disease onset. Compared with ERA patients without fever at disease onset, patients with fever had significantly more painful joints (3.5 vs. 2.8), more swollen joints (1.1 vs. 0.8), and more enthesitis (1.0 vs. 0.4) (p<0.05 for all comparisons). Patients with fever had significantly higher mean values of erythrocyte sedimentation rate, C-reactive protein, platelet count, and child health assessment questionnaire (CHAQ) scores (40.8 vs. 26.4 mm/h; 20.7 vs. 9.7 mg/dL; 353.2×109/L vs. 275.6×109/L; 1.0 vs. 0.8, respectively; all p<0.05). During two-year follow-up, CHAQ score, number of flares, as well as the number of patients treated with oral non-steroidal anti-inflammatory drugs, corticosteroids and combination therapy with disease-modifying anti-rheumatic drugs, were significantly higher in ERA patients with fever. Conclusions Fever was a frequent manifestation of ERA. ERA patients with fever had more active disease at disease onset and poorer outcomes than ERA patients without fever.
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Affiliation(s)
- Ruru Guo
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Lanfang Cao
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
- * E-mail:
| | - Xianming Kong
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Xuesong Liu
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Haiyan Xue
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Lijuan Shen
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Xiaoli Li
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
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Chistiakov DA, Savost’anov KV, Baranov AA. Genetic background of juvenile idiopathic arthritis. Autoimmunity 2014; 47:351-60. [DOI: 10.3109/08916934.2014.889119] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Back pain in the pediatric population is a common complaint presenting to sports medicine clinics. There is a wide differential that should be considered, including mechanical, infectious, neoplastic, inflammatory, and amplified musculoskeletal pain. The history, pain quality, and examination are key components to help distinguish the etiologies of the pain and direct further evaluation. Laboratory investigations, including blood counts and inflammatory markers, can provide insight into the diagnosis. The HLA-B27 antigen can be helpful if a spondyloarthropathy is suspected. Imaging as clinically indicated typically begins with radiographs, and the use of MRI, CT, or bone scan can provide additional information. Proper diagnosis of back pain is important because prognosis and treatments are significantly different. We review the pertinent evaluation, differential diagnoses, and treatment of low back pain in the pediatric population.
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Affiliation(s)
- Alysha J. Taxter
- Division of Rheumatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nancy A. Chauvin
- Division of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pamela F. Weiss
- Division of Rheumatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Abstract
Spondyloarthritis (SpA) encompasses a group of disorders linked by overlapping clinical manifestations and genetic predisposition. Newer classification systems developed for adults with SpA focus on identifying individuals with axial or predominantly peripheral involvement. All forms of SpA can begin during childhood, and can be considered on a continuum with adult disease. Nevertheless, there are important differences in presentation and outcome that depend on age at onset. This article highlights these differences, what has been learned about genetics and pathogenesis of SpA, and important unmet needs for future studies.
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Affiliation(s)
- Anusha Ramanathan
- Division of Rheumatology, Children’s Hospital Los Angeles and the University of Southern California, Los Angeles, CA 90027, USA, Tel: 323.361.8232,
| | - Hemalatha Srinivasalu
- Division of Rheumatology, Children’ National Medical Center and George Washington University, Washington, DC 20010, USA, Tel: 202.476.4674,
| | - Robert A. Colbert
- Pediatric Translational Research Branch, National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, Bethesda, MD 20892, USA Tel: 301.443.8935,
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