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Article

Enthesitis Related Arthritis in a Longitudinal Southeast Asian Registry: High Prevalence of HLA-B27, Different Sacroiliitis Risk Factors and Less Common Drug-Free Remission

1
Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
2
Duke-NUS Medical School, Pediatric Academic Clinical Program, Singapore 169857, Singapore
3
Division of Nursing, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
*
Author to whom correspondence should be addressed.
Academic Editor: Takako Miyamae
J. Clin. Med. 2021, 10(4), 568; https://doi.org/10.3390/jcm10040568
Received: 13 January 2021 / Revised: 29 January 2021 / Accepted: 30 January 2021 / Published: 3 February 2021
(This article belongs to the Special Issue Pediatric and Adolescent Rheumatology: A Rapidly Developing Field)
Objective. To describe the clinical characteristics, predictors and treatment of children with Enthesitis Related Arthritis (ERA) in a Singapore longitudinal cohort over 11 years. Methods. ERA patients were recruited from our registry (2009–2019). Nonparametric descriptive statistics including median (interquartile range, IQR) were used to describe data. Kaplan–Meier survival and logistic/Cox regression analyses were used to estimate the probabilities and determine predictors of clinical variables, respectively. The significance level was set at <0.05. Results. One hundred and forty-six ERA patients (87% male, 82% Chinese) were included. Median onset age was 11.9 years (IQR 9.4–14.0) and median disease duration was 4.9 years (IQR 2.6–8.3). Family history of Human Leukocyte Antigen (HLA)-B27 associated diseases was positive in 7.5%. Acute uveitis occurred in 3.4%. Oligoarthritis was present in 89.7%. Hip, knee and ankle joints were among the most common joints involved. One-fourth had enthesitis at diagnosis (Achilles tendon entheses, 82.9%). Sacroiliitis occurred in 61%. Probabilities of sacroiliitis development were 0.364, 0.448 and 0.578 at 1, 2 and 5 years after onset, respectively. Negative HLA-B27, female, older age at onset and hip arthritis at diagnosis were associated with shorter time for sacroiliitis development (p = 0.001–0.049). Methotrexate (MTX) remained the most common disease modifying anti-rheumatic drug (DMARD) used (77.4%). However, 77.9% required anti-TNF (aTNF) therapy secondary to MTX failure. Among MTX-treated sacroiliitis patients, 85.3% failed, requiring aTNF, as compared to 63.2%patients without axial disease. Longer duration to diagnosis (p = 0.038) and MTX use (p = 0.007) predicted aTNF therapy. None had joint deformity. Conclusions. This study underscores differences in ERA clinical characteristics, predictors and treatment responses. Our ERA population had many unique findings but good functional outcomes. View Full-Text
Keywords: juvenile idiopathic arthritis; enthesitis-related arthritis; Southeast Asia; predictors; Singapore; treatment juvenile idiopathic arthritis; enthesitis-related arthritis; Southeast Asia; predictors; Singapore; treatment
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MDPI and ACS Style

Arkachaisri, T.; Teh, K.L.; Book, Y.X.; Hoh, S.F.; Gao, X.; Das, L. Enthesitis Related Arthritis in a Longitudinal Southeast Asian Registry: High Prevalence of HLA-B27, Different Sacroiliitis Risk Factors and Less Common Drug-Free Remission. J. Clin. Med. 2021, 10, 568. https://doi.org/10.3390/jcm10040568

AMA Style

Arkachaisri T, Teh KL, Book YX, Hoh SF, Gao X, Das L. Enthesitis Related Arthritis in a Longitudinal Southeast Asian Registry: High Prevalence of HLA-B27, Different Sacroiliitis Risk Factors and Less Common Drug-Free Remission. Journal of Clinical Medicine. 2021; 10(4):568. https://doi.org/10.3390/jcm10040568

Chicago/Turabian Style

Arkachaisri, Thaschawee, Kai L. Teh, Yun X. Book, Sook F. Hoh, Xiaocong Gao, and Lena Das. 2021. "Enthesitis Related Arthritis in a Longitudinal Southeast Asian Registry: High Prevalence of HLA-B27, Different Sacroiliitis Risk Factors and Less Common Drug-Free Remission" Journal of Clinical Medicine 10, no. 4: 568. https://doi.org/10.3390/jcm10040568

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