title: Course of patients with juvenile spondyloarthritis during 4 years of observation, juvenile part of GESPIC.
abstract: OBJECTIVE
  To describe the course and the 4-year outcome of juvenile spondyloarthritis (jSpA).
  
  
  METHODS
  Patients with a diagnosis of jSpA and an age at onset ≤16 years were included in the German Spondyloarthritis Inception cohort (GESPIC) and followed up prospectively for 4 years.
  
  
  RESULTS
  118 patients (73% men, 66% HLA-B27 positive, mean age 13.5 years, mean symptom duration 2.2 years) were enrolled in 2 study centres: 52% of patients with jSpA were captured by the enthesitis-related arthritis subgroup of the International League of Associations for Rheumatology classification criteria. At inclusion, the majority of patients had active peripheral arthritis (75.4%), followed by inflammatory back pain (IBP) (19.5%) and enthesitis (16.1%). There was a significant improvement in clinical manifestations and in patient-reported outcomes over time. During the 4-year follow-up, 85% of the patients had at least 1 period of remission on drug ≥6 months, and 46% of the patients achieved remission ≥12 months without medication, of whom 68% kept this status and 32% worsened. At the end of 4 years of observation, 23% of the patients were in remission without medication, but 57% still suffered from active disease. Patients with peripheral arthritis had a likelihood of 29% for having peripheral arthritis after 4 years, whereas the likelihood of IBP persistence was 53% for those with IBP at enrolment.
  
  
  CONCLUSIONS
  Although 1 quarter of patients with jSpA achieved remission off medication after 4 years, the likelihood of having recurrent or persistent disease into adulthood is substantial, particularly for jSpA with IBP.
  
  
  BACKGROUND
  NCT 01277419.
authors.affiliation: German Rheumatism Research Center , Berlin , Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Weiß
authors.affiliation: German Rheumatism Research Center, Berlin, Germany; Charité University Medicine Berlin, Berlin, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Minden
authors.affiliation: German Rheumatism Research Center , Berlin , Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Listing
authors.affiliation: Hamburg Center for Pediatric Rheumatology , Hamburg , Germany.
authors.forename: Ivan
authors.initials: I
authors.lastname: Foeldvari
authors.affiliation: Charité University Medicine Berlin , Berlin , Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Sieper
authors.affiliation: Klinikum Bielefeld, Bielefeld, Germany; Charite University, Medicine, Berlin, Germany; Ghent University, Ghent, Belgium.
authors.forename: Martin
authors.initials: M
authors.lastname: Rudwaleit
keywords: Ankylosing Spondylitis; Arthritis; Spondyloarthritis