Lamot Lovro, Miler Marijana, Vukojević Rudolf, Vidović Mandica, Lamot Mirta, Trutin Ivana, Gabaj Nora Nikolac, Harjaček Miroslav
Division of Clinical Immunology and Rheumatology, Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia.
Front Med (Lausanne). 2021 Mar 8;8:650619. doi: 10.3389/fmed.2021.650619. eCollection 2021.
Enthesitis related arthritis (ERA) is a specific subtype of juvenile idiopathic arthritis (JIA), often regarded as an undifferentiated form of juvenile spondyloarthritis (jSpA). While gut is increasingly recognized as origin and/or target of inflammation in adult onset spondyloarthritis (SpA), the incidence of gut involvement in ERA patients is largely unknown. The aim of this study was to measure the concentration of fecal calprotectin (fCAL), a surrogate marker of gut inflammation, in patients with different subtypes of JIA, as well as to correlate the results with various demographic, clinical, laboratory, imaging, and treatment characteristics. The cross-sectional exploratory study involving 71 patients with ERA, other forms of JIA and children complaining musculoskeletal symptoms was therefore conducted. Along with fCAL assessment, a detailed clinical and laboratory examination was performed, including the calculation of a composite disease activity scores. Moreover, MRI of the sacroiliac joints was performed in all ERA and other patients complaining of low back pain. The median concentration of fCAL was highest in ERA patients (33.2 mg/kg, = 0.02), with a significant difference between those with inactive and active disease (20.0 vs. 57.4, = 0.01), as well as those with and without MRI signs of sacroiliitis (22.6 vs. 54.3, = 0.04). The fCAL did not differ depending on the NSAID use (23 vs. 20, = 0.18), although weak correlation was observed with the treatment duration ( = 0.25, = 0.03). In conclusion, our findings indicate that a parallel inflammation in musculoskeletal system and gut can occur not just in adults with SpA, but in children with ERA as well.
附着点炎相关关节炎（ERA）是幼年特发性关节炎（JIA）的一种特殊亚型，常被视为幼年脊柱关节炎（jSpA）的未分化形式。虽然肠道在成人起病的脊柱关节炎（SpA）中越来越被认为是炎症的起源和/或靶点，但ERA患者肠道受累的发生率很大程度上未知。本研究的目的是测量不同亚型JIA患者粪便钙卫蛋白（fCAL）的浓度，fCAL是肠道炎症的替代标志物，并将结果与各种人口统计学、临床、实验室、影像学和治疗特征相关联。因此，开展了一项横断面探索性研究，纳入了71例ERA患者、其他形式的JIA患者以及主诉肌肉骨骼症状的儿童。除了fCAL评估外，还进行了详细的临床和实验室检查，包括计算综合疾病活动评分。此外，对所有ERA患者和其他主诉下背痛的患者进行了骶髂关节MRI检查。ERA患者的fCAL中位数浓度最高（33.2mg/kg，P = 0.02），疾病活动和非活动患者之间（20.0对57.4，P = 0.01）以及有和无骶髂关节炎MRI体征的患者之间（22.6对54.3，P = 0.04）存在显著差异。fCAL不受非甾体抗炎药使用情况的影响（23对20，P = 0.18），尽管与治疗持续时间存在弱相关性（r = 0.25，P = 0.03）。总之，我们的研究结果表明，肌肉骨骼系统和肠道的平行炎症不仅会发生在成人SpA患者中，也会发生在儿童ERA患者中。
