Juvenile Spondyloarthropathies
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SERONEGATIVE ARTHRITIS (MA KHAN, SECTION EDITOR)
Juvenile Spondyloarthropathies R. Hal Scofield & Andrea L. Sestak
Published online: 22 August 2012 # Springer Science+Business Media, LLC (outside the USA) 2012
Abstract Spondyloarthropathy (or spondyloarthritis) can begin in childhood (defined as individuals less than 16 years of age). These diseases are distinct in childhood, when compared with adult-onset disease. Because of overlapping features, especially sacroiliac joint involvement, diagnostic difficulty may arise from Behcet’s disease, as well as familial Mediterranean fever. Despite advances in diagnostic techniques such as magnetic resonance imaging, the diagnosis of juvenile spondyloarthropathy may still be delayed many years from the onset of symptoms. Treatment of juvenile spondyloarthropathy has advanced rapidly in the last several years, with increasing evidence that agents targeting tumor necrosis factor are effective. These agents also have serious complications, including induction of other autoimmune diseases. Keywords Children . Juvenile . Ankylosing spondylitis . Spondyloarthropathy . Tumor necrosis factor . Treatment . Diagnosis . Differential diagnosis
Introduction In adults, there are several forms of spondyloarthropathy. These include patients with ankylosing spondylitis, for R. H. Scofield : A. L. Sestak Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation (RHS, ALS), Oklahoma City, OK, USA R. H. Scofield (*) : A. L. Sestak Department of Pediatrics (ALS) and Medicine (RHS), College of Medicine, University of Oklahoma Health Sciences Center, 825 NE 13th Street, MS24, Oklahoma City, OK 73104, USA e-mail: [email protected] R. H. Scofield : A. L. Sestak Department of Veterans Affairs Medical Center (RHS), Oklahoma City, OK, USA
which the usual diagnostic criteria do not have a lower age limit [1]. Other varieties of spondyloarthropathy in adults are reactive arthritis, arthritis associated with inflammatory bowel disease, psoriatic arthritis, and undifferentiated spondyloarthropathy [2]. In most patients with a spondyloarthropathy, the onset of disease is in adulthood, usually the third or fourth decade of life. Some patients with spondyloarthropathy begin to have symptoms before the age of 16 years; thus, they are said to have juvenile spondyloarthropathy. Juvenile spondyloarthropathy is, therefore, an important form of juvenile idiopathic arthritis and needs to be recognized independently and clearly because of the diagnostic, therapeutic, and prognostic implications. Furthermore, unlike the most common forms of juvenile idiopathic arthritis, most spondyloarthropathies have an equivalent disease with an adult onset. Despite this, the classification of spondyloarthropathy in children and adults is distinct. The classification and subtypes of idiopathic juvenile arthritis and the place of juvenile spondyloarthropathies within this classification system have recently been reviewed [3•]. On the basis of the latest version of the International League for Associ
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