Advances in the Diagnosis and Treatment of Enthesitis-Related Arthritis
Abstract
:1. Introduction
2. Methods
3. Historic Evolution of ERA Definition and Classification
Nomenclature | Enthesitis-Related Arthritis by ILAR Criteria | Enthesitis/Spondylitis-Related JIA by Provisional PRINTO Criteria |
---|---|---|
Inclusion criteria |
|
|
Exclusion criteria |
| None |
4. Epidemiology
5. Clinical Spectrum of ERA
5.1. Arthritis
5.1.1. Peripheral Arthritis
5.1.2. Axial Involvement
5.2. Enthesitis
5.3. Extra-Articular Manifestations
6. ERA Monitoring and Outcome
7. ERA Treatment
7.1. Current Therapeutic Recommendations
7.2. Emerging Biological Agents and Small Molecules
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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JIA Subtypes Defined by ILAR | Frequency 1 |
---|---|
Systemic arthritis | 4.2–33% |
Oligoarthritis | 10.8–56.7% |
Polyarthritis (Rheumatoid Factor positive) | 1.3–11.2% |
Polyarthritis (Rheumatoid Factor negative) | 12.7–31.5% |
Psoriatic arthritis | 1.3–7.1% |
Enthesitis-related arthritis | 5.4–29.8% |
Undifferentiated arthritis | 3.7–10.4% |
Anatomic Region | Sites for Entheseal Assessment |
---|---|
Chest | First and seventh costosternal junctions |
Upper extremity | Supraspinatus attachment into greater tuberosity of humerus |
Common flexor attachment at medial epicondyle of humerus Common extensor attachment at lateral epicondyle of humerus | |
Spine | Fifth lumbar spinous process |
Pelvis | Abdominal muscle attachments to iliac crest |
Sartorius attachment at anterior superior iliac spine | |
Posterior superior iliac spine | |
Hip extensor attachment at greater trochanter of femur | |
Gracilis and adduction attachment to pubis symphysis | |
Hamstrings attachment to ischial tuberosity | |
Knee | Quadriceps tendon attachment to patella (2 and 10 o’clock) |
Infrapatellar ligament attachment to patella (6 o’clock) and tibial tuberosity | |
Foot and ankle | Achilles tendon attachment to calcaneus |
Plantar fascia attachment to calcaneus | |
Plantar fascia attachment to metatarsal heads | |
Plantar fascia attachment to base of fifth metatarsal |
bDMARDs | Composition and Action Mechanism |
---|---|
Etanercept | TNF-α receptor fusion protein able to bind circulating TNF-α |
Adalimumab | Humanized monoclonal antibody binding both soluble and membrane-bound TNF-α |
Infliximab | Chimeric monoclonal antibody binding both soluble and membrane-bound TNF-α |
Golimumab | Human monoclonal antibody binding both soluble and membrane-bound TNF-α |
Secukimumab | Human monoclonal antibody that binds IL-17A, avoiding the activation of IL-17 pathway |
Ustekimumab | Human monoclonal antibody directed against the p40 subunit shared by IL-12 and IL-23, preventing the Th-17 cells activation |
Ixekizumab | Humanized monoclonal antibody targeting IL-17A, avoiding the activation of IL-17 pathway |
Tofacitinib | JAK1/JAK3 inhibitor able to prevent JAK-STAT cascade activation |
Baricitinib | JAK1/JAK2 inhibitor able to prevent JAK-STAT cascade activation |
Isolated Peripheral Arthritis (<5 Affected Joints) | Isolated Peripheral Arthritis (≥5 Affected Joints) * | Presence of Sacroiliitis * | Presence of Enthesitis * | |
---|---|---|---|---|
First-line therapy | IAGCs, trial of NSAIDs |
| NSAIDs | NSAIDs |
Inadequate responseto first-line therapy | csDMARD, with MTX as preferred agent |
|
|
|
Inadequate responseto second-line therapy | bDMARD | Switch to another bDMARD |
|
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Di Gennaro, S.; Di Matteo, G.; Stornaiuolo, G.; Anselmi, F.; Lastella, T.; Orlando, F.; Alessio, M.; Naddei, R. Advances in the Diagnosis and Treatment of Enthesitis-Related Arthritis. Children 2023, 10, 1647. https://doi.org/10.3390/children10101647
Di Gennaro S, Di Matteo G, Stornaiuolo G, Anselmi F, Lastella T, Orlando F, Alessio M, Naddei R. Advances in the Diagnosis and Treatment of Enthesitis-Related Arthritis. Children. 2023; 10(10):1647. https://doi.org/10.3390/children10101647
Chicago/Turabian StyleDi Gennaro, Simona, Gennaro Di Matteo, Gianmarco Stornaiuolo, Federica Anselmi, Teresa Lastella, Francesca Orlando, Maria Alessio, and Roberta Naddei. 2023. "Advances in the Diagnosis and Treatment of Enthesitis-Related Arthritis" Children 10, no. 10: 1647. https://doi.org/10.3390/children10101647
APA StyleDi Gennaro, S., Di Matteo, G., Stornaiuolo, G., Anselmi, F., Lastella, T., Orlando, F., Alessio, M., & Naddei, R. (2023). Advances in the Diagnosis and Treatment of Enthesitis-Related Arthritis. Children, 10(10), 1647. https://doi.org/10.3390/children10101647