Lamot Lovro, Harjaček Miroslav
Reumatizam. 2016;63 Suppl 1:59-65.
Juvenile spondyloartrhritis is a group of multifactorial diseases in which a disturbed interplay occurs between the immune system and environmental factors on a predisposing genetic background, which leads to inflammation and structural damage of the target tissue. First symptoms of jSpA rarely involve the spine, while asymmetrical oligoarthritis of lower extremities, dactylitis, and peripheral enthesitis are much more common. There are many classification criteria for jSpA, but the majority of pediatric rheumatologists currently use the International League Against Rheumatism (ILAR) criteria according to which most patients with jSpA are classified into the enthesitis-related arthritis group of juvenile idiopathic arthritis. To meet these criteria, a patient should have arthritis and/or enthesitis, with two or more symptoms such as sacroiliac joint tenderness and/or inflammatory back pain, HLAB27 genotype, HLA B27 genotype-associated disease in a first- or second-degree relative, uveitis, and male sex with eight or more years of age. Therefore, diagnosis is most oft en made only based on clinical examination and medical history. Anti- nuclear antibodies (ANA), rheumatoid factor (RF), and HLA testing with B27, B7, and DR4 alleles are preferred. Since subclinical gut inflammation is present in many patients, it is recommended to check fecal calprotectin levels. In patients with signs of peripheral enthesitis it is warranted to perform power Doppler musculoskeletal ultrasound (PDUS), and in patients with signs of axial involvement radiographic and contrast-enhanced magnetic resonance imaging. Most patients are treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy, while in refractory cases with peripheral disease synthetic disease- modifying antirheumatic drugs (DMARDs), such as sulfasalazine, are used. In patients with axial involvement, biological DMARDs such as adalimumab, infliximab, and etanercept are obligatory. Although a number of studies gave us a good insight into the disease pathogenesis, the response to treatment and prognosis are still difficult to predict.
青少年脊柱关节炎是一组多因素疾病，在易感基因背景下，免疫系统与环境因素之间发生相互作用紊乱，导致靶组织炎症和结构损伤。青少年脊柱关节炎的首发症状很少累及脊柱，而下肢不对称性少关节炎、指（趾）炎和外周附着点炎更为常见。青少年脊柱关节炎有许多分类标准，但目前大多数儿科风湿病学家使用国际抗风湿病联盟（ILAR）标准，根据该标准，大多数青少年脊柱关节炎患者被归类为青少年特发性关节炎的附着点炎相关关节炎组。要符合这些标准，患者应有关节炎和/或附着点炎，并伴有两种或更多症状，如骶髂关节压痛和/或炎性背痛、HLAB27基因型、一级或二级亲属中与HLA B27基因型相关的疾病、葡萄膜炎以及8岁及以上男性。因此，诊断通常仅基于临床检查和病史。首选检测抗核抗体（ANA）、类风湿因子（RF）以及HLA B27、B7和DR4等位基因。由于许多患者存在亚临床肠道炎症，建议检查粪便钙卫蛋白水平。对于有外周附着点炎体征的患者，有必要进行能量多普勒肌肉骨骼超声（PDUS）检查，对于有轴向受累体征的患者，则需进行X线和对比增强磁共振成像检查。大多数患者采用非甾体抗炎药（NSAIDs）和物理治疗，而对于外周疾病难治性病例，则使用合成改善病情抗风湿药（DMARDs），如柳氮磺胺吡啶。对于有轴向受累的患者，必须使用生物DMARDs，如阿达木单抗、英夫利昔单抗和依那西普。尽管多项研究让我们对该疾病的发病机制有了很好的了解，但治疗反应和预后仍然难以预测。
