Recognition and treatment of juvenile-onset spondyloarthritis.
OBJECTIVE
The purpose of this review is to discuss the classification, diagnosis and management of juvenile-onset spondyloarthritis.


RESULTS
There have been changes in the classification criteria for juvenile-onset spondyloarthritis and magnetic resonance imaging has allowed for earlier detection of disease. Additionally, tumor necrosis factor-alpha blockers have been shown to be effective in the treatment of ankylosing spondylitis. There is evidence to suggest that early treatment may lead to better response. A high percentage of patients with enthesitis-related arthritis progress to develop ankylosing spondylitis within 10 years after presentation. Patients with juvenile-onset ankylosing spondylitis appear to have poorer functional outcomes.


CONCLUSIONS
Juvenile-onset spondyloarthritis has variable clinical features that may lead to significant impairments. Improved classification criteria exist, but better techniques that are more sensitive are needed to diagnose disease earlier. New therapies appear to improve outcomes, but randomized controlled trials are needed in this population of patients.
Gensler
Lianne
L
Clinical Research Center, University of California-San Francisco, 533 Parnassus Avenue, San Francisco, CA 94143, USA.
Davis
John C
JC
D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D013167:Spondylitis, Ankylosing / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism
D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha