Clinical Analysis Of HLA-B27-Positive Enthesitis Related Arthritis In 70 Cases

Objective: To investigate the clinical features,auxiliary examination,treatment and efficacy of Human Leucocyte Antigen-B27(HLA-B27)-positive enthesitis-related arthritis(ERA).Methods: The clinical datas of HLA-B27-positive ERA diagnosed in the Children ’ s Hospital of Chongqing Medical University from January2007 to August 2017 were analyzed retrospectively.Results: A total of 70 children were enrolled,including 67 males and3 females,and the average age of onset was(10.08±2.67)years old.(1)Clinical features: all children were with peripheral arthritis with or without enthesitis,and axial arthritis symptoms appeared in 17(24.3%)children,and 25(35.7%)children showed enthesitis.The onsets of the 61(87.1%)children were peripheral arthritis,and all cases showed peripheral arthritis during the course of the disease,mostly the knees.Two cases were complicated with uveitis.47(67.1%)cases were positive for Patrick test and 9(12.9%)had sacroiliac joint tenderness.The average juvenile arthritis disease activity score with 27 joints(JADAS27)was 20.12 ± 8.61.27(38.6%)children had a positive family history.(2)Auxiliary examination:erythrocyte sedimentation rate(ESR),C reactive protein(CRP)and platelet were elevated in most children,and a few with leukocytosis elevated slightly,nearly half of children with anemia mildly to moderately,and serum tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-1β,IL-10 levels were elevated(81.3%,75%,37.5% and 12.5% respectively).31/35(88.2%)children had decreased bone mass;the positive rate of X-ray examination was 81.1%,including 5 cases sacroiliac joint disease;the positive rate of ultrasonography was 81.5%;the positive rate of Magnetic resonance imaging(MRI)was 95.1%,including 30 cases sacroiliitis.(3)Treatment and outcome: nonsteroidal antiinflammatory drugs(NSAIDs),disease modifying antirheumatic drugs(DMARDs),glucocorticoids,calcium and alfacalcidol were added according to patient’s condition,and35(50%)children were added TNF-α antagonist.All the follow-up children were improved with clinical symptoms,laboratory indicators and JADAS27 score after standard treatments.Conclusion: It is difficult to diagnose and easily misdiagnosed because of the lack of specificity of ERA clinical symptoms.The improvement of imaging techniques,especially MRI which is sensitive to early joint synovial lesions and sacroiliac joint lesions,is helpful for the early diagnosis of ERA.To strengthen the understanding and management of ERA,especially HLA-B27-positive ERA,and to grasp its clinical features,immunology and imaging features,help to make timely diagnosis and reasonable treatment,and to improve physical function and quality of life of patients,avoid or delay the disability.