8Spondylarthropathies in children—are they different from those in adults?
Section snippets
What spondylarthropathies present in childhood?
Juvenile spondylarthropathies (JSpAs) comprise a group of rheumatic diseases with onset before the age of 16 years and which are characterized by arthritis and enthesitis, inflammatory back pain, and association with HLA-B27. Since inflammatory back pain is seldom present in the initial clinical presentation, spondylarthropathies are often difficult to distinguish from some other forms of childhood chronic arthritis. Different entities have been described: undifferentiated spondylarthropathies,
Is making a diagnosis different from that in adults?
The most helpful feature to distinguish JSpAs from other forms of juvenile arthritis forms is enthesitis. In particular, oligoarthritis in the lower limbs accompanied by enthesitis in an adolescent boy should always suggest juvenile spondylarthropathy. However, pain at entheses may also be secondary to excessive physical exercise. Prominent tibial tuberosity pain suggests Osgood-Schlatter disease, even in children with spondylarthropathy. In this disorder, swelling and pain over the tibial
What is the role of imaging and HLA-B27 in paediatric spondylarthropathies?
Imaging is helpful in paediatric spondylarthropathies to define the exact diagnosis, to evaluate the persistence of joint inflammation, the damage to bone, joints and adjacent structures, and to measure bone mineral content. Radiographic evidence of sacroiliitis is a diagnostic hallmark of spondylarthropathies in adults. However, in children the interpretation of conventional radiographs of sacroiliac joints is often difficult, and sacroiliitis is rare early in the course of JSpA. By
How to manage spondylarthropathies in children—drug and non-drug approaches
Like other forms of juvenile arthritis, spondylarthropathies in children need to be managed by a paediatric multidisciplinary team taking into account the different medical, rehabilitation and psychosocial needs of the patient, and integrating the management of the illness into the dynamics of growth and development. This multidisciplinary team will provide the necessary care, but also educate the patient and the parents in understanding the diagnosis, the chronicity of the disease, the
What is the benefit of exercise therapy?
Rehabilitation measures are part of the treatment of patients with juvenile arthritis to restore and maintain the functional ability of the patient. Indeed, nearly 60% of children with JSpA have moderate to severe limitations after 10 years of disease.45 Early and continued physical and occupational therapy is mandatory, and should focus on maintaining muscle strength and the range of motion of affected joints. Prescription should also include exercises for the mobility of the spine and the
What is the role of disease-modifying drugs, including biologicals?
Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line of treatment in JSpA. They are used at similar doses as for other JIA forms and usually bring significant relief of pain and stiffness. The control of pain often occurs during the first 48 hours in about two thirds of the patients, much as in adults.5 However, some JSpA patients respond poorly to NSAIDs, and these drugs do not alter disease progression. Intra-articular steroid injection (triamcinolone hexacetanomide) may resolve
Acknowledgements
I would like to thank Alexander So for critical reading of the manuscript.
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2012, American Journal of the Medical SciencesCitation Excerpt :The main problem with applying these recommendations to children is that to be classified with axial SpA requires 3 months of back pain. This would exclude, or at least delay, treatment of a number of individuals due to differences in disease presentation in children.41 One approach to the treatment of JSpA would utilize recommendations established for adults when they are appropriate.