Enthesitis-related arthritis: current perspectives

Rutviz Rajendra Mistry,1 Pallavi Patro,2 Vikas Agarwal,1 Durga Prasanna Misra1 1Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India; 2Department of Pharmacology, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, India Abstract: In...

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Autores principales:	Mistry RR, Patro P, Agarwal V, Misra DP
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	enthesitis related arthritis juvenile spondyloarthropathy diagnosis management exercise anti TNF Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/22400b4c39314509a5fc8c8df9c8b597
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spelling	oai:doaj.org-article:22400b4c39314509a5fc8c8df9c8b5972021-12-02T00:29:52ZEnthesitis-related arthritis: current perspectives1179-156Xhttps://doaj.org/article/22400b4c39314509a5fc8c8df9c8b5972019-01-01T00:00:00Zhttps://www.dovepress.com/enthesitis-related-arthritis-current-perspectives-peer-reviewed-article-OARRRhttps://doaj.org/toc/1179-156XRutviz Rajendra Mistry,1 Pallavi Patro,2 Vikas Agarwal,1 Durga Prasanna Misra1 1Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India; 2Department of Pharmacology, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, India Abstract: In this narrative review, we overview the recent literature on enthesitis-related arthritis (ERA). For the purpose of our review, we searched Scopus for recent articles on this subject from 2013 onward, including some classic older articles for perspective. ERA is a juvenile idiopathic arthritis (JIA) subtype more common in males, associated in a majority with human leucocyte antigen B27. Such children generally present with asymmetric oligoarthritis or polyarthritis, predominantly of lower limb joints, associated with enthesitis or sacroiliitis. While diagnosis remains clinical, ultrasound is being increasingly used to detect subclinical enthesitis and for guiding entheseal site injections. Spine MRI can help detect sacroiliitis, inflammatory spinal changes, and pelvic sites of enthesitis in such patients. The recent juvenile spondyloarthropathy disease activity index recognizes the key clinical features of ERA, viz enthesitis and inflammatory back pain, which other disease activity indices used in JIA did not include. Management includes NSAIDs with physical therapy. Conventional disease-modifying agents like sulfasalazine and methotrexate may be used to minimize duration of NSAID use and in those with high inflammatory burden. In patients refractory to these drugs, biologics such as antitumor necrosis factor alpha agents have proven useful, based on evidences from randomized controlled trials and retrospective registry analyses. Factors predicting a poorer outcome in such children include hip or ankle involvement or restricted spinal mobility. Considering that children with ERA have overall poorer long-term outcomes than other subtypes of JIA, there is a need to further optimize therapeutic strategies for such patients. Keywords: enthesitis-related arthritis, juvenile spondyloarthropathy, diagnosis, management, exercise, anti-TNFMistry RRPatro PAgarwal VMisra DPDove Medical Pressarticleenthesitis related arthritisjuvenile spondyloarthropathydiagnosismanagementexerciseanti TNFDiseases of the musculoskeletal systemRC925-935ENOpen Access Rheumatology: Research and Reviews, Vol Volume 11, Pp 19-31 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	enthesitis related arthritis juvenile spondyloarthropathy diagnosis management exercise anti TNF Diseases of the musculoskeletal system RC925-935
spellingShingle	enthesitis related arthritis juvenile spondyloarthropathy diagnosis management exercise anti TNF Diseases of the musculoskeletal system RC925-935 Mistry RR Patro P Agarwal V Misra DP Enthesitis-related arthritis: current perspectives
description	Rutviz Rajendra Mistry,1 Pallavi Patro,2 Vikas Agarwal,1 Durga Prasanna Misra1 1Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India; 2Department of Pharmacology, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, India Abstract: In this narrative review, we overview the recent literature on enthesitis-related arthritis (ERA). For the purpose of our review, we searched Scopus for recent articles on this subject from 2013 onward, including some classic older articles for perspective. ERA is a juvenile idiopathic arthritis (JIA) subtype more common in males, associated in a majority with human leucocyte antigen B27. Such children generally present with asymmetric oligoarthritis or polyarthritis, predominantly of lower limb joints, associated with enthesitis or sacroiliitis. While diagnosis remains clinical, ultrasound is being increasingly used to detect subclinical enthesitis and for guiding entheseal site injections. Spine MRI can help detect sacroiliitis, inflammatory spinal changes, and pelvic sites of enthesitis in such patients. The recent juvenile spondyloarthropathy disease activity index recognizes the key clinical features of ERA, viz enthesitis and inflammatory back pain, which other disease activity indices used in JIA did not include. Management includes NSAIDs with physical therapy. Conventional disease-modifying agents like sulfasalazine and methotrexate may be used to minimize duration of NSAID use and in those with high inflammatory burden. In patients refractory to these drugs, biologics such as antitumor necrosis factor alpha agents have proven useful, based on evidences from randomized controlled trials and retrospective registry analyses. Factors predicting a poorer outcome in such children include hip or ankle involvement or restricted spinal mobility. Considering that children with ERA have overall poorer long-term outcomes than other subtypes of JIA, there is a need to further optimize therapeutic strategies for such patients. Keywords: enthesitis-related arthritis, juvenile spondyloarthropathy, diagnosis, management, exercise, anti-TNF
format	article
author	Mistry RR Patro P Agarwal V Misra DP
author_facet	Mistry RR Patro P Agarwal V Misra DP
author_sort	Mistry RR
title	Enthesitis-related arthritis: current perspectives
title_short	Enthesitis-related arthritis: current perspectives
title_full	Enthesitis-related arthritis: current perspectives
title_fullStr	Enthesitis-related arthritis: current perspectives
title_full_unstemmed	Enthesitis-related arthritis: current perspectives
title_sort	enthesitis-related arthritis: current perspectives
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/22400b4c39314509a5fc8c8df9c8b597
work_keys_str_mv	AT mistryrr enthesitisrelatedarthritiscurrentperspectives AT patrop enthesitisrelatedarthritiscurrentperspectives AT agarwalv enthesitisrelatedarthritiscurrentperspectives AT misradp enthesitisrelatedarthritiscurrentperspectives
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Enthesitis-related arthritis: current perspectives

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