Enthesitis related arthritis (ERA) is a subtype of juvenile idiopathic arthritis (JIA) and is associated with the HLA B27 antigen. The International League of Associations for Rheumatology (ILAR) defines ERA using the following criteria: (1) Any patient with both arthritis and enthesitis; (2) the presence of arthritis or enthesitis with two of the following features: Sacroiliac joint tenderness, inflammatory spinal pain, or both; HLA B27 family history in 1st degree relative of medically confirmed HLA B27-associated disease; acute anterior uveitis; onset of arthritis in a boy after the age of 6 yr. Of note, patients with psoriasis or with psoriasis in a 1st degree relative are also excluded.
Juvenile enthesitis-related arthritis
Enthesitis related arthritis, juvenile
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BOX E1 Radiographic Features of Enthesitis-Related Arthritis and Spondyloarthropathies
From Petty RE et al: Textbook of pediatric rheumatology, ed 8, Philadelphia, 2021, Elsevier.
Figure E1 A 17-yr-old girl with enthesitis-related arthritis.
A, The forefoot x-ray examination shows joint space narrowing and extensive bone erosions involving multiple metatarsophalangeal joints, especially the fifth metatarsophalangeal joint. B, A spur is noted in the hindfoot x-ray examination at the insertion of the plantar fascia (white arrow) and erosive changes at the calcaneal tendon insertion (black arrow). C, Sagittal contrast-enhanced fat-suppressed T1-weighted magnetic resonance imaging shows intense enhancement adjacent to the calcaneal tendon, heel, and metatarsophalangeal joint.
From Petty RE et al: Textbook of pediatric rheumatology, ed 8, Philadelphia, 2021, Elsevier.
Figure E2 An 11-yr-old boy with enthesitis-related arthritis.
A, Magnetic resonance imaging shows bilateral hip joint effusions and abnormal bone signal adjacent to the left sacroiliac joint and left greater trochanter (arrows). Whereas the coronal T1-weighted image (A) shows low signal in these regions (arrows), the coronal short tau inversion recovery image (B) shows increased signal intensity.
From Petty RE et al: Textbook of pediatric rheumatology, ed 8, Philadelphia, 2021, Elsevier.
Physical therapy, heat therapy, and cold therapy can be used to address the musculoskeletal pain associated with the disease.
Acute treatment typically includes monotherapy or combination therapy with NSAIDs and methotrexate/sulfasalazine
If patients are not able to achieve control, of their symptoms with the above regimen, antitumor necrosis factor (anti-TNF) medications such as etanercept and adalimumab