Enthesitis-related juvenile arthritis, psoriatic arthritis and arthritis in chronic intestinal inflammation in children. Reactive arthritis in children. Juvenile spondyloarthritis 4.5/5 (2)

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Definition

Entesite-related arthritis in children, a type of juvenile arthritis (juvenile idiopathic arthritis, JIA) is characterized by arthritis (arthritis) in large joints and inflammation of tendon attachments (enthesitis). Boys from 9-12 years of age are most frequently attacked. Encephalitis-related arthritis accounts for 10% of all people with juvenile arthritis. Bekhterev's disease (ankylosing spondylitis) in the immediate family is not uncommon.

Psoriatic arthritis / psoriatic arthritis accounts for less than 10% of juvenile arthritis. Unlike encephalitis-related arthritis, twice as many girls as boys are attacked. Most are 7-10 years old at the onset of the disease. Psoriasis in the skin present in most people, although symptoms from joints may occur before skin manifestations. Psoriasis among parents or siblings is common.

Chronic Intestinal Inflammation (IBD) consists of Crohn's disease og Ulcerative colitis. Crohn's disease is most common among these in boys and girls. Both conditions can cause symptoms such as encephalitis-related arthritis.

Reactive arthritis is less common in children than young adults. The symptoms occur a few weeks after an infection in the throat or intestine and are similar to enthesitis-related arthritis. The condition usually resolves on its own within weeks-months and thus has a better prognosis.

Symptoms

Joint inflammation in the knees, ankles or hips of boys over 6 years of age is typical, although other conditions (differential diagnoses) must be ruled out (see below). Other joints can also become inflamed and often one joint is attacked at a time (asymmetric arthritis).

Back pain. Later in the course (ten-year-olds), increasing back pain occurs gradually with stiffness, mostly in the morning. Back pain and stiffness get better with activity and worse from being at rest. The cause is inflammation of the joints between the lower back and the pelvis (iliosacral joints).

Inflammation of tendons (entheses) occurs, often in Achilles tendons on the heel and without other cause.

Acute eye inflammation, uveitis can occur at any time during the process. Pain when looking at light and irritation may occur, but asymptomatic eye inflammation is not uncommon in children. Permanently reduced vision is a risk. Children with the genetic tissue type HLA-B27 are most at risk.

Examinations

Entesite-related Childhood Arthritis (JIA)
Pediatric arthritis (Enthesitis related JIA) with arthritis of the iliosacral joint (arrows in MRI images). Herregods N, Pediatr Rheumatol Online J (2015). CC BY 4.0

Medical history includes whether others in close relatives have Bekhterev's disease (ankylosing spondylitis), Psoriasis or Crohn's disease / Ulcerative colitis. Signs of previous infection, which joints are attacked, signs of changes in tendon attachments, eyes, skin and intestines are in demand.

Clinical examine eyes, joints, back, tendons and skin. Dactylitis (swollen finger or toe) can be seen. In psoriatic arthritis occurs nail changes ("Pitting" or onycholysis) with or without Psoriasis in the skin.

Blood tests includes CRP and lowering response (SR) which is usually elevated. The tissue type HLA-B 27 occurs in most people with encephalitis-related arthritis, but also among 8-10% of all people in southern Norway and is even more common in northern Norway. The result must therefore be interpreted with caution. "Rheumatism tests" such as CCP antibody and ANA usually do not work.

Urin test is expected to be normal.

Imaging. Ultrasound and MRI (Magnet resonance tomography) -examinations of joints will show signs of arthritis. After a few months with symptoms from the back, MRI will often show signs of inflammation. However, MRI changes in the back and iliosacral joints in children must be interpreted with caution because normal growth changes may resemble inflammation. Before the age of 13-14, the results are uncertain. MRI changes in the spine (excluding iliosacral joints) develop gradually from adolescence in some.

Optometrist. If eye manifestations are suspected, the child must be examined by an ophthalmologist. A general screening annually is also recommended (please see the chapter on oligoarticular JIA) (reference: Rodriguex-GArzia A, 2015)

Diagnosis

To make the diagnosis, a thorough assessment of medical history, clinical, laboratory and imaging tests is required. In addition, one will often need to observe the course over weeks-a few months. Thus, diagnosis almost always takes some time.

Treatment

Physiotherapy to improve and maintain movement, strength and posture and other interdisciplinary treatment can be important.

Many children have a good effect of NSAIDs (ibuprofen, naproxen and others) used for symptoms. If swollen joints (peripheral arthritis), joint punctures and injections of cortisone are in the form of LederSpan, Triamcinolonheksacetonid are often useful. Some also need supplementary disease modifying treatment with Methotrexate. Also biological drugs as TNF inhibitors etanercept, adalimumab, infliximab are used. Against Eye Affection (uveitis) does not have etanercept effect.

Spondyloarthritis (spondyloarthropathy) in adults here

Literature

Children with rheumatic disease, BINDEVEVSSYKDOMMER.no


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