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Rheumatology73 papers

Juvenile spondyloarthropathy

Last edited: 4/14/2026

Overview

Juvenile spondyloarthropathies (JSpA) are chronic inflammatory diseases affecting children under 16 years, characterized by enthesitis, lower extremity oligoarthritis, axial skeleton involvement, and often HLA B27 positivity, differing from other juvenile idiopathic arthritis subtypes 14.

Diagnosis

  • Key Criteria: Enthesitis, lower extremity oligoarthritis, axial skeleton involvement, HLA B27 positivity 14.
  • Recommended Tests: MRI of sacroiliac joints for inflammatory changes, conventional radiography for sacroiliitis, and laboratory tests to rule out other conditions 31030.
  • Classification Tools: European Spondyloarthropathy Study Group (ESSG) criteria and Amor criteria are used but have varying sensitivity and specificity 411.
  • Imaging: CT and MRI can aid in assessing sacroiliac joint involvement, especially in pediatric patients 30.

    • Management

  • First-Line Treatments: Nonsteroidal anti-inflammatory drugs (NSAIDs) for symptom control 113.
  • Adjunctive Therapies: Disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine or methotrexate if NSAIDs are insufficient 13.
  • Biologics: Anti-TNF agents for refractory cases, though specific pediatric dosing guidelines are limited 5.
  • Physical Therapy: Essential for maintaining mobility and function 19.

    • Special Populations

  • Pediatrics: ESSG and Amor criteria may require adaptation for juvenile onset; careful monitoring of growth and development 111.
  • Comorbidities: JSpA can present with extra-articular manifestations like uveitis or gastrointestinal involvement, necessitating multidisciplinary care 225.

    • Key Recommendations

  • Utilize ESSG and Amor criteria for classification, acknowledging variability in diagnostic sensitivity and specificity (Evidence: Moderate) 411.
  • Initiate treatment with NSAIDs for symptom management; escalate to DMARDs or biologics in refractory cases (Evidence: Moderate) 113.
  • Incorporate physical therapy as a core component of management to preserve joint function (Evidence: Expert opinion) 19.
  • Screen for and manage extra-articular manifestations, such as uveitis and gastrointestinal symptoms, to ensure comprehensive care (Evidence: Moderate) 225.

    • References

    1 Türkuçar S, Sözeri B, Sönmez HE, Şahin N, Açarı C, Dundar HA et al.. Defining Inactivity of Juvenile Spondyloarthropathies: Delphi Study Among Pediatric Rheumatology Academy (PeRA) From Türkiye. International journal of rheumatic diseases 2026. link 2 Gutteridge IF. 'Can you touch your toes?' spondyloarthropathies and acute anterior uveitis for primary eyecare practitioners. Clinical & experimental optometry 2022. link 3 Barnsley L, Paiva J, Barnsley L. Frequency of pertinent MRI abnormalities of the sacroiliac joints of patients without spondyloarthropathies: a systematic review of the literature. Skeletal radiology 2021. link 4 Adrovic A, Sezen M, Barut K, Sahin S, Acikel C, Demirkaya E et al.. The performance of classification criteria for juvenile spondyloarthropathies. Rheumatology international 2017. link 5 Macfarlane GJ, Barnish MS, Jones EA, Kay L, Keat A, Meldrum KT et al.. The British Society for Rheumatology Biologics Registers in Ankylosing Spondylitis (BSRBR-AS) study: Protocol for a prospective cohort study of the long-term safety and quality of life outcomes of biologic treatment. BMC musculoskeletal disorders 2015. link 6 López-González R, Hernández-Sanz A, Almodóvar-González R, Gobbo M. Are spondyloarthropathies adequately referred from primary care to specialized care?. Reumatologia clinica 2013. link 7 Son CN, Bang SY, Kim JH, Choi CB, Kim TH, Jun JB. Caspase-1 level in synovial fluid is high in patients with spondyloarthropathy but not in patients with gout. Journal of Korean medical science 2013. link 8 Cohen JD, Cunin P, Farrenq V, Oniankitan O, Carton L, Chevalier X et al.. Estimation of the Bath Ankylosing Spondylitis Disease Activity Index cutoff for perceived symptom relief in patients with spondyloarthropathies. The Journal of rheumatology 2006. link 9 Rothschild BM. Primate spondyloarthropathy. Current rheumatology reports 2005. link 10 Nash P, Mease PJ, Braun J, van der Heijde D. Seronegative spondyloarthropathies: to lump or split?. Annals of the rheumatic diseases 2005. link 11 Kasapçopur O, Demirli N, Ozdoğan H, Apelyan M, Calişkan S, Sever L et al.. Evaluation of classification criteria for juvenile-onset spondyloarthropathies. Rheumatology international 2005. link 12 Kiratiseavee S, Brent LH. Spondyloarthropathies: using presentation to make the diagnosis. Cleveland Clinic journal of medicine 2004. link 13 Miceli-Richard C, van der Heijde D, Dougados M. Spondyloarthropathy for practicing rheumatologists: diagnosis, indication for disease-controlling antirheumatic therapy, and evaluation of the response. Rheumatic diseases clinics of North America 2003. link00045-0) 14 Wendling D, Toussirot E, Michel F. Spondyloarthropathy and retroperitoneal fibrosis: a case report. Joint bone spine 2002. link00404-9) 15 Gomariz EM, del M, Guijo VP, Contreras AE, Villanueva M, Estévez EC. The potential of ESSG spondyloarthropathy classification criteria as a diagnostic aid in rheumatological practice. The Journal of rheumatology 2002. link 16 Rothschild BM, Rothschild C, Woods RJ. Inflammatory arthritis in canids: spondyloarthropathy. Journal of zoo and wildlife medicine : official publication of the American Association of Zoo Veterinarians 2001. link032[0058:IAICS]2.0.CO;2) 17 Lehman TJ. Enthesitis, arthritis, and heel pain. Journal of the American Podiatric Medical Association 1999. link 18 Viitanen JV. Do pathological opposites cancel each other out? Do all patients with both hypermobility and spondylarthropathy fulfill a criterion of any disease?. Scandinavian journal of rheumatology 1999. link 19 Dougados M, Revel M, Khan MA. Spondylarthropathy treatment: progress in medical treatment, physical therapy and rehabilitation. Bailliere's clinical rheumatology 1998. link80046-0) 20 McGonagle D, Gibbon W, Emery P. Classification of inflammatory arthritis by enthesitis. Lancet (London, England) 1998. link12004-9) 21 Rothschild BM, Sebes JI, Rothschild C. Antiquity of arthritis: spondyloarthropathy identified in the Paleocene of North America. off. Clinical and experimental rheumatology 1998. link 22 Rothschild BM, Pingitore C, Eaton M. Dactylitis: implications for clinical practice. Seminars in arthritis and rheumatism 1998. link80027-9) 23 al-Mayouf SM, Babyn P, Schneider R, Silverman ED, Laxer RM. Patellar enthesopathy in childhood: a new clinical and radiographic observation. The Journal of rheumatology 1997. link 24 Rothschild BM, Woods RJ. Inflammatory arthritis in Pongo. Journal of medical primatology 1996. link 25 Hertzberger-ten Cate R, Dijkmans BA, Breedveld FC. Teenager with an irritable hip, anaemia and malaise. Annals of the rheumatic diseases 1995. link 26 Amor B, Dougados M, Listrat V, Menkes CJ, Roux H, Benhamou C et al.. Are classification criteria for spondylarthropathy useful as diagnostic criteria?. Revue du rhumatisme (English ed.) 1995. link 27 Sprenkels SH, Linssen A, Feltkamp TE. Spondylarthropathy and selective IgA deficiency. Rheumatology international 1995. link 28 Rothschild BM. Arthritis of the spondyloarthropathy variety in Callithrix jacchus. Journal of medical primatology 1993. link 29 Veys EM, Mielants H, Joos R, De Clercq L. Juvenile spondyloarthropathies in 1992. The Journal of rheumatology. Supplement 1993. link 30 Oudjhane K, Azouz EM, Hughes S, Paquin JD. Computed tomography of the sacroiliac joints in children. Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes 1993. link 31 Rothschild BM, Woods RJ. Erosive arthritis and spondyloarthropathy in Old World primates. American journal of physical anthropology 1992. link 32 Creamer P, Edmonds J. Spondyloarthropathies. Australian family physician 1990. link 33 Troise Rioda W, Ferraccioli GF. DISH and ankylosing spondylitis. Case report and review of the literature. Clinical and experimental rheumatology 1990. link 34 Herrero-Beaumont G, Armas JB, Elswood J, Will RK, Calin A. Selective IgA deficiency and spondyloarthropathy: a distinct disease?. Annals of the rheumatic diseases 1990. link 35 Olivieri I, Gemignani G, Christou C, Pasero G. Trauma and seronegative spondyloarthropathy: report of two more cases of peripheral arthritis precipitated by physical injury. Annals of the rheumatic diseases 1989. link 36 Olivieri I, Gemignani G, Siciliano G, Gremignai G, Pasero G. Tarsal tunnel syndrome in seronegative spondyloarthropathy. British journal of rheumatology 1989. link 37 Sampson HW. Spondyloarthropathy in progressive ankylosis (ank/ank) mice: morphological features. Spine 1988. link 38 Ellis BI, Shier CK, Leisen JJ, Kastan DJ, McGoey JW. Acne-associated spondylarthropathy: radiographic features. Radiology 1987. link 39 Messaris G, Vamvoukakis J, Papakonstantinou A. Chronic spondyloarthropathy mimicking abdominal disease. International surgery 1983. link 40 Rosner IA, Richter DE, Huettner TL, Kuffner GH, Wisnieski JJ, Burg CG. Spondyloarthropathy associated with hidradenitis suppurative and acne conglobata. Annals of internal medicine 1982. link

    Original source

    1. [1]
      Defining Inactivity of Juvenile Spondyloarthropathies: Delphi Study Among Pediatric Rheumatology Academy (PeRA) From Türkiye. — Türkuçar S, Sözeri B, Sönmez HE, Şahin N, Açarı C, Dundar HA et al. International journal of rheumatic diseases (2026)
    2. [2]
      'Can you touch your toes?' spondyloarthropathies and acute anterior uveitis for primary eyecare practitioners. — Gutteridge IF Clinical & experimental optometry (2022)
    3. [3]
      Frequency of pertinent MRI abnormalities of the sacroiliac joints of patients without spondyloarthropathies: a systematic review of the literature. — Barnsley L, Paiva J, Barnsley L Skeletal radiology (2021)
    4. [4]
      The performance of classification criteria for juvenile spondyloarthropathies. — Adrovic A, Sezen M, Barut K, Sahin S, Acikel C, Demirkaya E et al. Rheumatology international (2017)
    5. [5]
      The British Society for Rheumatology Biologics Registers in Ankylosing Spondylitis (BSRBR-AS) study: Protocol for a prospective cohort study of the long-term safety and quality of life outcomes of biologic treatment. — Macfarlane GJ, Barnish MS, Jones EA, Kay L, Keat A, Meldrum KT et al. BMC musculoskeletal disorders (2015)
    6. [6]
      Are spondyloarthropathies adequately referred from primary care to specialized care? — López-González R, Hernández-Sanz A, Almodóvar-González R, Gobbo M Reumatologia clinica (2013)
    7. [7]
      Caspase-1 level in synovial fluid is high in patients with spondyloarthropathy but not in patients with gout. — Son CN, Bang SY, Kim JH, Choi CB, Kim TH, Jun JB Journal of Korean medical science (2013)
    8. [8]
      Estimation of the Bath Ankylosing Spondylitis Disease Activity Index cutoff for perceived symptom relief in patients with spondyloarthropathies. — Cohen JD, Cunin P, Farrenq V, Oniankitan O, Carton L, Chevalier X et al. The Journal of rheumatology (2006)
    9. [9]
      Primate spondyloarthropathy. — Rothschild BM Current rheumatology reports (2005)
    10. [10]
      Seronegative spondyloarthropathies: to lump or split? — Nash P, Mease PJ, Braun J, van der Heijde D Annals of the rheumatic diseases (2005)
    11. [11]
      Evaluation of classification criteria for juvenile-onset spondyloarthropathies. — Kasapçopur O, Demirli N, Ozdoğan H, Apelyan M, Calişkan S, Sever L et al. Rheumatology international (2005)
    12. [12]
      Spondyloarthropathies: using presentation to make the diagnosis. — Kiratiseavee S, Brent LH Cleveland Clinic journal of medicine (2004)
    13. [13]
      Spondyloarthropathy for practicing rheumatologists: diagnosis, indication for disease-controlling antirheumatic therapy, and evaluation of the response. — Miceli-Richard C, van der Heijde D, Dougados M Rheumatic diseases clinics of North America (2003)
    14. [14]
      Spondyloarthropathy and retroperitoneal fibrosis: a case report. — Wendling D, Toussirot E, Michel F Joint bone spine (2002)
    15. [15]
      The potential of ESSG spondyloarthropathy classification criteria as a diagnostic aid in rheumatological practice. — Gomariz EM, del M, Guijo VP, Contreras AE, Villanueva M, Estévez EC The Journal of rheumatology (2002)
    16. [16]
      Inflammatory arthritis in canids: spondyloarthropathy. — Rothschild BM, Rothschild C, Woods RJ Journal of zoo and wildlife medicine : official publication of the American Association of Zoo Veterinarians (2001)
    17. [17]
      Enthesitis, arthritis, and heel pain. — Lehman TJ Journal of the American Podiatric Medical Association (1999)
    18. [18]
      Do pathological opposites cancel each other out? Do all patients with both hypermobility and spondylarthropathy fulfill a criterion of any disease? — Viitanen JV Scandinavian journal of rheumatology (1999)
    19. [19]
      Spondylarthropathy treatment: progress in medical treatment, physical therapy and rehabilitation. — Dougados M, Revel M, Khan MA Bailliere's clinical rheumatology (1998)
    20. [20]
      Classification of inflammatory arthritis by enthesitis. — McGonagle D, Gibbon W, Emery P Lancet (London, England) (1998)
    21. [21]
      Antiquity of arthritis: spondyloarthropathy identified in the Paleocene of North America. off. — Rothschild BM, Sebes JI, Rothschild C Clinical and experimental rheumatology (1998)
    22. [22]
      Dactylitis: implications for clinical practice. — Rothschild BM, Pingitore C, Eaton M Seminars in arthritis and rheumatism (1998)
    23. [23]
      Patellar enthesopathy in childhood: a new clinical and radiographic observation. — al-Mayouf SM, Babyn P, Schneider R, Silverman ED, Laxer RM The Journal of rheumatology (1997)
    24. [24]
      Inflammatory arthritis in Pongo. — Rothschild BM, Woods RJ Journal of medical primatology (1996)
    25. [25]
      Teenager with an irritable hip, anaemia and malaise. — Hertzberger-ten Cate R, Dijkmans BA, Breedveld FC Annals of the rheumatic diseases (1995)
    26. [26]
      Are classification criteria for spondylarthropathy useful as diagnostic criteria? — Amor B, Dougados M, Listrat V, Menkes CJ, Roux H, Benhamou C et al. Revue du rhumatisme (English ed.) (1995)
    27. [27]
      Spondylarthropathy and selective IgA deficiency. — Sprenkels SH, Linssen A, Feltkamp TE Rheumatology international (1995)
    28. [28]
      Arthritis of the spondyloarthropathy variety in Callithrix jacchus. — Rothschild BM Journal of medical primatology (1993)
    29. [29]
      Juvenile spondyloarthropathies in 1992. — Veys EM, Mielants H, Joos R, De Clercq L The Journal of rheumatology. Supplement (1993)
    30. [30]
      Computed tomography of the sacroiliac joints in children. — Oudjhane K, Azouz EM, Hughes S, Paquin JD Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes (1993)
    31. [31]
      Erosive arthritis and spondyloarthropathy in Old World primates. — Rothschild BM, Woods RJ American journal of physical anthropology (1992)
    32. [32]
      Spondyloarthropathies. — Creamer P, Edmonds J Australian family physician (1990)
    33. [33]
      DISH and ankylosing spondylitis. Case report and review of the literature. — Troise Rioda W, Ferraccioli GF Clinical and experimental rheumatology (1990)
    34. [34]
      Selective IgA deficiency and spondyloarthropathy: a distinct disease? — Herrero-Beaumont G, Armas JB, Elswood J, Will RK, Calin A Annals of the rheumatic diseases (1990)
    35. [35]
      Trauma and seronegative spondyloarthropathy: report of two more cases of peripheral arthritis precipitated by physical injury. — Olivieri I, Gemignani G, Christou C, Pasero G Annals of the rheumatic diseases (1989)
    36. [36]
      Tarsal tunnel syndrome in seronegative spondyloarthropathy. — Olivieri I, Gemignani G, Siciliano G, Gremignai G, Pasero G British journal of rheumatology (1989)
    37. [37]
      Spondyloarthropathy in progressive ankylosis (ank/ank) mice: morphological features. — Sampson HW Spine (1988)
    38. [38]
      Acne-associated spondylarthropathy: radiographic features. — Ellis BI, Shier CK, Leisen JJ, Kastan DJ, McGoey JW Radiology (1987)
    39. [39]
      Chronic spondyloarthropathy mimicking abdominal disease. — Messaris G, Vamvoukakis J, Papakonstantinou A International surgery (1983)
    40. [40]
      Spondyloarthropathy associated with hidradenitis suppurative and acne conglobata. — Rosner IA, Richter DE, Huettner TL, Kuffner GH, Wisnieski JJ, Burg CG Annals of internal medicine (1982)
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