Low frequency of axial involvement in southern Italian Caucasian children with HLA-B27 positive juvenile onset undifferentiated spondyloarthritis.
OBJECTIVE
To establish how many children with HLA B27-positive juvenile undifferentiated spondyloarthritis (JuSpA) living in southern Italy develop axial disease after 5 years of disease.


METHODS
All children with B27-positive enthesitis-related arthritis (ERA) consecutively seen in a 7-year period were entered in a special register and were followed prospectively. Each patient was examined at 6-month intervals, even if asymptomatic. In patients with inflammatory spinal pain and/or buttock pain, MRI of the sacroiliac joints and spine was performed. Five years after inclusion, sacroiliac joint plain radiographs were obtained and read blindly after being mixed with those of control subjects.


RESULTS
Thirteen children, 9 boys and 4 girls, with B27-positive ERA and one girl with B27-positive isolated SpA dactylitis were seen in the study period. Their median age at disease onset and at our first examination were 10 (range 2-16) and 12 years (range 3-16), respectively. During follow-up, only one patient had axial symptoms, i.e. alternate buttock pain. MRI revealed moderate bone oedema at both sacroiliac joints. After five years of disease, no patient showed reduced spinal movement. No sign of sacroiliitis was seen in any patient and control on plain films. A new MRI of the sacroiliac joints of the patient who showed bone oedema in the first years of disease was normal.


CONCLUSIONS
This study confirms that the onset of axial involvement in Italian Caucasian HLA-B27 positive children with ERA is rare in the first five years of disease.
Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie of Matera, Italy. ignazioolivieri@tiscalinet.it
Ignazio
I
Olivieri
Maria Stefania
MS
Cutro
Salvatore
S
D'Angelo
Pietro
P
Leccese
Gianna Angela
GA
Mennillo
Enrico
E
Scarano
Rosaria
R
Abate
Carlo
C
Palazzi
Angela
A
Padula
D000293:Adolescent; D017668:Age of Onset; D001416:Back Pain / Q000208:ethnology / Q000209:etiology / Q000276:immunology / Q000473:pathology; D015415:Biomarkers / Q000097:blood; D001696:Biomechanical Phenomena; D002081:Buttocks; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004487:Edema / Q000208:ethnology / Q000209:etiology / Q000276:immunology / Q000473:pathology; D005260:Female; D015796:HLA-B27 Antigen / Q000097:blood*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology* / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012042:Registries; D012446:Sacroiliac Joint / Q000473:pathology* / Q000503:physiopathology; D025242:Spondylarthropathies / Q000150:complications* / Q000175:diagnosis / Q000208:ethnology / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data
D015415:Biomarkers; D015796:HLA-B27 Antigen