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Lovro Lamot
Miroslav Harjaček

Puni tekst: hrvatski pdf 116 Kb

preuzimanja: 1.057



Juvenile spondyloartrhritis is a group of multifactorial diseases in which a disturbed interplay occurs
between the immune system and environmental factors on a predisposing genetic background, which leads to infl ammation
and structural damage of the target tissue. First symptoms of jSpA rarely involve the spine, while asymmetrical
oligoarthritis of lower extremities, dactylitis, and peripheral enthesitis are much more common. Th ere are many classifi
cation criteria for jSpA, but the majority of pediatric rheumatologists currently use the International League Against
Rheumatism (ILAR) criteria according to which most patients with jSpA are classifi ed into the enthesitis-related arthritis
group of juvenile idiopathic arthritis. To meet these criteria, a patient should have arthritis and/or enthesitis,
with two or more symptoms such as sacroiliac joint tenderness and/or infl ammatory back pain, HLAB27 genotype,
HLA B27 genotype-associated disease in a fi rst- or second-degree relative, uveitis, and male sex with eight or more
years of age. Th erefore, diagnosis is most oft en made only based on clinical examination and medical history. Antinuclear antibodies (ANA), rheumatoid factor (RF), and HLA testing with B27, B7, and DR4 alleles are preferred. Since
subclinical gut infl ammation is present in many patients, it is recommended to check fecal calprotectin levels. In patients
with signs of peripheral enthesitis it is warranted to perform power Doppler musculoskeletal ultrasound (PDUS),
and in patients with signs of axial involvement radiographic and contrast-enhanced magnetic resonance imaging.
Most patients are treated with nonsteroidal anti-infl ammatory drugs (NSAIDs) and physical therapy, while in refractory
cases with peripheral disease synthetic disease- modifying antirheumatic drugs (DMARDs), such as sulfasalazine,
are used. In patients with axial involvement, biological DMARDs such as adalimumab, infl iximab, and etanercept are
obligatory. Although a number of studies gave us a good insight into the disease pathogenesis, the response to treatment
and prognosis are still diffi cult to predict.

Ključne riječi

Spondylarthritis – complications, diagnosis, genetics, immunology, therapy; Genetic predisposition to disease; HLA B27 antigen; Sacroiliac joint; Tendinopathy – etiology; Achilles tendon; Enteritis – etiology; Antirheumatic agents – therapeutic use

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