Spondyloarthropathies (SpA) in children (ICD-10 M08.1)
- Psoriatic arthritis: Make up less than 10% of child joints. Also available as psoriasis arthritis in adulthood. Twice as many girls as boys are attacked. Most are 7-10 years at disease start. Typical of the disease is Arthritis og Psoriasis or arthritis and at least 2 of the following
- Entesite-related arthritis (ICD-10 M08.1) includes approx. 10% of JIA. Entesitis means inflammation in Achilles or other tendons. Girl to boy distribution is 1: 7 and the most common age for disease start is 9-12 years. The knees, ankles and hip joint are most commonly attacked. Acute uveitis (eye inflammation) occurs. Some have or develop chronic inflammation of the bowel (IBD) in the form of Ulcerative colitis or Crohn's disease. Chronic pain and stiffness in the back occur. Typical of Entesitt-related arthritis is arthritis and entesitis or entesitis with at least 2 of the following:
- Occurrence of pain in sacroiliac joints (SI-joint) or Inflammatory back pain (gradual onset, better with activity, duration> 3 months
- HLA-B 27 antigen (blood sample)
- Arthritis debut among boys after 6's age
- First degree relative (parents, siblings) with Ankylosing spondylite (Bekhterevs), entesitis-related arthritis, Sacroiliitis by IBD (ulcerative colitis or Crohn's), Reactive arthritis (Reiters) or acute anterior uveitis (Inflammation of iris in the eye).
3. Undifferentiated arthritis typically has joint manifestation, but does not completely meet any of the criteria above.
MRI of iliac artery at entesit related child joints
Important for a definite diagnose is also arthritic changes in sacroiliac joints. MRI (Magnet resonance tomography) (with contrast medium, alternatively with STIR sequences) shows safe changes at the earliest.
- Before the age of 13-14, however, the results are difficult to interpret, partly because of growth zones.
- MRI changes in the spine develop gradually from adolescence in some.
Many children have a good effect of NSAIDs (ibuprofen, naproxen and others). If swollen joints (peripheral arthritis), joint punctures and injections with LederSpan, Triamcinolonheksacetonid are often useful. Some also need supplementary disease modifying treatment with Methotrexate. Also biological drugs as etanercept (Benepali, Enbrel), Adalimumab (Humira), infliximab (Rixathon, Remicade, Remsima) are used. Against Eye Affection (uveitis) does not have etanercept effect.
- More about juvenile spondyloartropathies can be read here (in Danish) (In English, Akin E, 2008 pdf.)
- Weiss A, 2017 (Over 4 Year)