Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
Pediatr Rheumatol Online J. 2023 Feb 6;21(1):13. doi: 10.1186/s12969-023-00792-0.
Axial involvement in children with enthesitis-related arthritis (ERA) has characteristics that differ from those of peripheral involvement. This study characterized their clinical characteristics and treatment.
Patients with ERA at the Children's Hospital of Nanjing Medical University between January 2018 and December 2020 were included. The ERA cohort was divided into two based on the presence or absence of axial joint involvement. Demographic characteristics, clinical features, and treatments were described and compared.
In total, 105 children with ERA were enrolled (axial ERA, n = 57; peripheral ERA, n = 48). The age at disease onset of the axial group tended to be higher (11.93 ± 1.72 vs. 11.09 ± 1.91 years) and the diagnosis delay was bigger in patients with axial ERA (10.26 ± 11.66 months vs. 5.13 ± 7.92 months). The inflammatory marker levels were significantly higher in patients with axial. There were no differences in HLA-B27 positivity between the groups (34 [59.65%] vs. 28 [58.33%], P > 0.05). Hip involvement was more frequent in the axial group (52.63% vs 27.08%; X = 7.033). A total of 38 (66.67%) and 10 (20.83%) patients with axial and peripheral ERA, respectively, were treated with biological disease-modifying anti-rheumatic drugs (DMARDs) at diagnosis. The administration of biologics increased gradually in the axial ERA group, peaking at 18 months and decreasing thereafter, whereas that in the peripheral ERA group peaked at 6 months and began to decline thereafter.
Axial ERA is a persistent active disease and requires a more aggressive treatment. Classification and early recognition of axial involvement may help with timely diagnosis and appropriate management.
附着点相关关节炎（ERA）患儿的中轴受累与外周受累有不同的特点。本研究对其临床特征和治疗方法进行了描述。
纳入 2018 年 1 月至 2020 年 12 月南京医科大学附属儿童医院的 ERA 患儿。根据是否存在中轴关节受累，将 ERA 患儿分为中轴组和外周组。描述并比较两组患儿的人口统计学特征、临床表现和治疗方法。
共纳入 105 例 ERA 患儿（中轴 ERA 组 57 例，外周 ERA 组 48 例）。中轴组患儿发病年龄较高（11.93±1.72 岁比 11.09±1.91 岁），中轴 ERA 患儿的诊断延迟更大（10.26±11.66 个月比 5.13±7.92 个月）。中轴组患儿的炎症标志物水平显著升高。两组患儿 HLA-B27 阳性率无差异（34 例[59.65%]比 28 例[58.33%]，P＞0.05）。中轴组髋关节受累更为常见（52.63%比 27.08%，X²=7.033）。中轴组和外周组分别有 38（66.67%）和 10（20.83%）例患儿在确诊时即接受生物 DMARDs 治疗。中轴组患儿生物 DMARDs 的使用率逐渐增加，在 18 个月时达到峰值，此后逐渐下降；而外周组患儿在 6 个月时达到峰值，此后开始下降。
中轴 ERA 是一种持续性活动疾病，需要更积极的治疗。对中轴受累的分类和早期识别可能有助于及时诊断和适当管理。
