Spondyloarthropathies
Objectives- Describe the clinical diagnostic features of spondyloarthropathies in chilren
- List three spondyloarthropathies in children
- Describe the natural history of ankylosing spondylitis in children
Discussion points
- What diagnoses might be made on patients with ankylosing spondylitis if the diagnosis of ankylosing spondylitis was not considered?
Discussion
The spondyloarthropathies, or sero-negative spondyloarthropathies as they are sometimes known, since the rheumatoid factor is negative, are probably more commmon in children than previously thought. They are strongly linked to HLA-B27, and in the general population, their incidence is linked to the incidence of HLA-B27. Certain non HLAB27 genetic markers can also factor in the incidence of spondyloarthropathies. It is likely that many children with spondyloarthropathies have been diagnosed as having oligoarticular juvenile arthritis. There is a definite male preponderance to the spondyloarthropathies. The etiology is complex, in addition to HLA=B27, bacterial antigens and DNA have been found in the joints of patients with Reiter's syndrome (RS), and IgA, IgM, and IgG antibodies against bacterial antigens have been found in patients with ankylosing spondylitis (AS). The gut is also involved in some way, a recent study documented increased gut activity accompanying AS even in the absence of GI symptoms. Psoriatic arthritis, which usually has its onset between the ages of 7 and 11, is another spondyloarthropathy.
Patinets with spondyloarthropathies have combined arthritis and enthesitis (inflammation of tendon or ligament), first peripherally and then centrally. Enthesitis of the feet is characteristic, manifested by Achilles tendinitis, plantar fasciitis, and other tendon-bone junctions. The knee and hip joints are often involved. Spinal and SI joint involvement follow, often years later. The initial symptoms are in the thoracic and lumbar spine. Pain does not improve with movement, it often worsens during the day. Chest expansion is not reduced in children with early AS.
The spondyloarthropathies are presently treated with nonsteriodal agents and physical therapy. There is seldom any indication for surgery for problems associated with spondyloarthopathies. General fitness levels are decreased in these chronically affected children.
References
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May 16-19, 2012 in Denver, CO
