Department of Pediatrics, Brookdale University Hospital and Medical Center, New York, NY; and State University of New York Health Science Center at Brooklyn, Brooklyn, NY.
Department of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY; and Department of Clinical Pediatrics, Weill Cornell Medicine, New York, NY.
Pediatr Rev. 2021 Nov;42(11):581-589. doi: 10.1542/pir.2020-000810.
is a blanket term encompassing entities such as enthesitis-related arthritis, nonradiographic axial SpA, and ankylosing spondylitis. These diseases share many clinical features, including a predilection for inflammation of the entheses and the sacroiliac joints. The nomenclature is based on the evolution of the classification of the disease and the age of the patient. SpA has a prevalence of approximately 1% of the population of the United States, with 10% to 20% of patients experiencing the onset during childhood. Children with onset of arthritis before age 16 years are classified as having juvenile idiopathic arthritis. Children with enthesitis and/or sacroiliitis are further classified as belonging to the enthesitis-related arthritis subtype of juvenile idiopathic arthritis. The initial manifestations can be subtle and will usually include a peripheral pattern of arthritis and enthesitis. It may take several years for axial disease to develop in children. Except for an association with the human leukocyte antigen (HLA-B27) serotype, there are no laboratory markers for the disease, and the radiographic findings are often negative. A careful clinical evaluation for evidence of inflammation in the entheses and the joints and a search for comorbidities are required. Magnetic resonance imaging facilitates the early detection of sacroiliitis, an important feature that may be clinically silent. Because recent studies indicate that earlier introduction of therapy can help achieve better outcomes, rapid identification and treatment of children with SpA is essential.
是一个包含许多疾病实体的总称，如附着点炎相关关节炎、非放射学中轴型脊柱关节炎和强直性脊柱炎。这些疾病具有许多共同的临床特征，包括附着点和骶髂关节炎症的倾向。该命名法基于疾病分类的演变和患者年龄。SpA 的流行率在美国人群中约为 1%，其中 10%至 20%的患者在儿童时期发病。16 岁以下发病的关节炎患儿被归类为幼年特发性关节炎。有附着点炎和/或骶髂关节炎的患儿进一步分类为幼年特发性关节炎的附着点炎相关关节炎亚型。初始表现可能较为隐匿，通常包括外周关节炎和附着点炎。儿童中轴疾病的发展可能需要数年时间。除了与人类白细胞抗原（HLA-B27）血清型有关外，该疾病没有实验室标志物，且放射学表现通常为阴性。需要仔细评估附着点和关节炎症的临床证据，并寻找合并症。磁共振成像有助于早期发现骶髂关节炎，这是一个重要的特征，可能在临床上无症状。由于最近的研究表明，早期引入治疗可以帮助获得更好的结果，因此快速识别和治疗 SpA 患儿至关重要。
