Features of enthesitis related arthritis in Turkish children

Background

In the ILAR criteria the category enthesitis related arthritis (ERA) best describes juvenile ankylosing spondylitis.

Aim

To evaluate the features of patients who met the ERA criteria in an eastern European background.

Patients and methods

Forty-five patients with ERA were enrolled to the study. Clinical data and laboratory data were assessed. Ultrasonographic examination was performed in 36 patients.

Results

There were 4 female and 41 male patients. Mean age of the patients was 14.1 ± 2.31 years. Mean age of the diagnosis was 12, 6 ± 2, 21 years. Arthritis was present in 97% and median number of swollen joints was 1. Sacroileitis was present in 2/3 of the patients. In 68.9% of the patients HLA B27 was positive and 55.6% of the patients had elevated acute phase response. MEFV mutations were present in nine. Uveitis was present in 8.9%. Family history was present in 26.7%. Enthesitis was reported in 42.2% during physical examination. Ultrasonographic evaluation showed enthesitis and synovial effusion in half of these patients. In only one of these the physical examination had missed the enthesitis. Furthermore tendinitis and bursitis was detected in 11.1% and 13.9%, respectively. Nonsteroid anti-inflammatory drugs (97.%) and salazopyrin (71.1%) were the first choice of treatment.

Conclusion

In our population HLA-B27 was less frequent and most of the negative patients had MEFV mutations. In this small series there was marked sacroiliac involvement. The joint distribution was similar; however, enthesitis was less frequent compared to other series. Ultrsonographic evaluation was a practical and important aid to management.