| Juvenile-onset spondyloarthropathics is a group of rheumatic diseases with unclear etiology, which associated with the HLA-B27, always before 16-year- old. The clinical performances are the inflammation and hyperplasia of the central and peripheral tendon, arthritis and extra-articular lesions. Disease activity in long-term caused damage of organizational structure, produced different degrees of dysfunction, so that the quality of life decline. The disease can be divided into two subtypes of continuity and overlapping. The early of the diseases is stereotypes which based on inflammation and the later is with certain clinical characteristics, which include juvenile ankylosing spondylitis, juvenile Rett syndrome, childhood reactive arthritis, psoriatic arthritis and juvenile inflammatory bowel disease related arthritis. Because of the lack of awareness of JSpA, clinical misdiagnosis, misuse governance are quite common. With the proposed of the spondylarthropathies concept and the diagnostic criteria by Amor and ESSG (Europe spondyloarthropathy study group) in1990, JSpA has been accepted by more and more scholars, because it is conducive to the early diagnosis of some juvenile arthritis.Genetic factors may be involved in the pathogenesis. However, the exact etiology and pathogenesis is not yet clear. Since 1973 found that HLA-B27 and ankylosing spondylitis is closely related, HLA-B27 is also closely related to the other spondyloarthropathy (Psoriatic arthritis by 50 percent, ankylosing spondylitis more than 90%) .Early performance of the disease mainly appear with the lower extremity peripheral arthritis and tendon inflammation,which can be accompanied by fever, fatigue, anemia, weight loss, psoriasis, urethritis, colitis, and other non-specific performance. With the progress of the course , upper extremity joint or axis joints can be involved. Ultimately it developed into a specific disease. When the axis joints involved ,in adults the spinal was mainly involved, and prone to appear calcification and bone ankylosis in the disc annulus fibrosus and the surrounding ligament, leading to the spinal dysfunction;but sacroiliac joint involvement was more often in the children. Early damage to the joint mainly involved lower limb joints such as knee, ankle and tarsal bone, which show the single non-symmetrical arthritis. With the progress of the disease, hip, foot and upper limb joints can be involved. Late in movement disorders and joint contracture. Tendon inflammation is mainly in the lower extremities. Generally the disease can partial or complete remission months later, but can be repeated attack. In addition fair-combined with a tendon and joint diseases, known as disease- seronegative tendon and joint syndrome, is the best indicator to forecast JSPA.Generally peripheral joint involvement rarely performance for destructive and continuing. Once the sacroiliac joint involvement, ankylosis, it will seriously affect the self-care ability of children, and become the main reason for young men maimed.From years of clinical research at home and abroad to see, if given active treatment, the prognosis of JSpA is relatively good, early diagnosis and treatment are key. At present, the treatment for JSpA is mainly based on the information of juvenile rheumatoid arthritis and adult SpA. Treatment methods include non-steroidal anti-inflammatory drugs, methotrexate, glucocorticoid, cyclosporine A, orthopaedic surgery and so on. In recent years, thalidomide and TNF-a antagonist has been used in the treatment of ankylosing spondylitis and spondyloarthropathy, and recently received effect. Thalidomide has the effect of anti-inflammatory and inhibit the TNF-a. But in JSpA there is lack of special reports.At present, the pathogenesis, early diagnosis, medication and treatment evaluation of the spondylarthropathies are unclear or not sure, so there is no accepted prognostic indicators. There are reports at home and abroad, the hip joints, sacroiliac joints and the foot tarsal bone involvement is often poor prognosis indicators of JSpA. Especially sacroiliac joint involvement is sensitive indicators of poor prognosis for JSpA.Based on the above understanding, both at home and abroad are now in the search for improved methods to diagnose JSpA earlier. Early active treatment can effectively improve the prognosis. The report about the progress is more, but to the present, both at home and abroad is still no such reports,which clearly hints the relative clinical indicators of JSpA with sacroiliac joint damage ,to guide clinical early treatment. Therefore, we need to find the related factors,which easily lead sacroiliac joint damage ,and give early intervention therapy. Thereby delaying or avoiding the occurrence of disability.ObjectiveDiscuss the relevant factors of Juvenile spondyloarthropathy patients with sacroiliac joint damage, to provide a basis for the selection of appropriate treatment programmes.MethodsResearch samples:117 cases of JSpA patients, who visit or hospitalized in the third of the Jilin University Clinical College (China- Japan Union Hospital) paediatrics, orthopaedics or Jilin Province Changchun City Children's Hospital's from January 1999 to December 2007. The diagnostic criteria is based on Amor standard and the European spondyloarthropathy Research Group (ESSG) standard.Research factors: demographic factors(sex,age,etc), genetic factors, joint symptoms, extra-articular manifestations, laboratories indicators, and so on.Outcome factors: sacroiliac joint damage, no damage to the sacroiliac joint.Statistical analysis: using logistic regression to select related factors for juvenile-onset spondyloarthropathy with sacroiliac joint damage, and establish the Logistic regression model. P <0.05 was thought statistical significance. To calculate the advantages ratio of various factors (OR value) and 95% confidence interval (IC) to show the related risk.All statistics are used SPSS13.0 statistical computing software, completed on the computer.Results54 patients have sacroiliac joint damage in the 117 cases of this group, of 46.2%. Logistic regression single factor analysis showed that the duration, at the onset of peripheral arthritis, tendon-sustained inflammation and hip pain, hip damage, HLA-B27, ESR, family history is the relative risk factors of JSpA sacroiliac joint damage. Multivariate Logistic regression analysis showed that the course of disease, at the onset of peripheral arthritis, tendon-sustained inflammation and hip pain, HLA-B27, family history is the relative risk factors of JSpA with sacroiliac joint damage.ConclusionJSpA is a common joints disease in the children,Which has higher morbidity. Particularly sacroiliac joint damage is more common. This should improve the early diagnosis of disease and use formal treatment programmes. When patients with family history of rheumatic diseases, HLA- B27-positive, at the onset of peripheral arthritis, especially the knee, sustained- tendon inflammation , hip pain, and longer duration of any one, it must be caused vigilance, to give early treatment and adhere to long-term follow-up ,to monitor the disease closely, especially to regularly check the sacroiliac joint CT or MRI. To enhance the long-term remission rate of JSpA and avoid or delay the occurrence of youth with disabilities. |
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