Rheumatology Division, Botucatu Medical School, São Paulo State University (UNESP), Sao Paulo, Brazil.
Pediatric Rheumatology Division, Botucatu Medical School, São Paulo State University (UNESP), Sao Paulo, Brazil.
Adv Rheumatol. 2024 May 8;64(1):39. doi: 10.1186/s42358-024-00378-8.
Juvenile idiopathic arthritis (JIA) comprises a whole spectrum of chronic arthritis starting before 16 years of age. The study aims to explore the clinical and demographic descriptors, treatment, and disease progression of enthesitis-related arthritis (ERA) in comparison with juvenile-onset spondyloarthritis (SpA).
Cross-sectional analysis of consecutive patients in two dedicated clinics, with a single visit and retrospective case-notes review. Arthritis, enthesitis and sacroiliitis were evaluated by scoring disease activity and damage. Continuous variables were reported by median, interquartile range; categorical variables were reported by the frequency comparison of the two groups.
Thirty-three cases were included, being 23 (69.7%) with ERA. The median age at diagnosis was 12.5 y (SpA) vs. 9 y (ERA) (p < 0.01); the time from symptom onset to diagnosis was 5.5 y (SpA) vs. 1.5 y (ERA) (p < 0.03). In both groups, the predominant presentation was a single joint or < 5 lower limb joints and asymmetric involvement, with a high frequency of enthesitis. There was a higher frequency of mid-tarsal and ankle synovitis in the ERA group and hip involvement in those with SpA. The comparison of the frequency of spine symptoms at presentation, 30% SpA vs. 21.7% ERA (p = 0.7), was not significant, and radiographic progression to spinal involvement occurred in 43.5% of ERA patients. The median time for spinal progression and age at onset was 2.2 and 12 y for ERA, and 4 and 16.5 y for SpA, respectively. Activity and damage scores were not significantly different between the groups. Treatment comparison resulted in 91.3% of ERA and 100% SpA being treated, predominantly with NSAIDs in both groups, followed by DMARDs and biologics, with a higher frequency of biologics in SpA.
The main differences were the late diagnoses of SpA, and the hip and spine involvement, with higher frequency of biologic treatment in juvenile-onset SpA compared to ERA.
幼年特发性关节炎（JIA）是一组在 16 岁之前开始的慢性关节炎，涵盖了整个疾病谱。本研究旨在比较附着点相关关节炎（ERA）与幼年发病型脊柱关节炎（SpA）的临床和人口统计学特征、治疗方法和疾病进展情况。
对两家专门诊所的连续患者进行横断面分析，患者只进行一次就诊，回顾性查阅病历。通过评分评估关节炎、附着点炎和骶髂关节炎的疾病活动度和损伤情况。连续变量用中位数和四分位距表示，分类变量用两组间的频率比较表示。
共纳入 33 例患者，其中 23 例（69.7%）为 ERA。诊断时的中位年龄为 12.5 岁（SpA）与 9 岁（ERA）（p<0.01）；从症状出现到诊断的时间为 5.5 年（SpA）与 1.5 年（ERA）（p<0.03）。在两组中，主要表现为单一关节或<5 个下肢关节受累且呈不对称性，附着点炎的发生率较高。ERA 组中跗骨和踝关节滑膜炎的发生率较高，而 SpA 组中髋关节受累的发生率较高。ERA 组和 SpA 组在就诊时脊柱症状的频率比较，分别为 30%和 21.7%（p=0.7），差异无统计学意义，ERA 患者中有 43.5%出现脊柱进展。ERA 患者脊柱进展的中位时间和发病年龄分别为 2.2 年和 12 岁，SpA 分别为 4 年和 16.5 年。两组的活动度和损伤评分无显著差异。治疗比较结果显示，91.3%的 ERA 和 100%的 SpA 患者接受了治疗，两组均以 NSAIDs 为主要治疗药物，随后是 DMARDs 和生物制剂，SpA 组中生物制剂的使用频率更高。
主要区别在于 SpA 的诊断较晚，以及髋关节和脊柱受累，幼年发病型 SpA 比 ERA 更常使用生物制剂治疗。
