Last update:


Arch Hellen Med, 31(3), May-June 2014, 286-297


Juvenile spondyloarthritis: The criteria that do not unravel the problem of a complicated diagnosis

E. Tsitsami
Pediatric Rheumatology Unit, First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece

Spondyloarthritis (SpA) encompasses a group of inflammatory joint diseases with overlapping features that accounts for up to 15–20% of cases of arthritis in children. In children, SpA at onset is often undifferentiated and is less likely to involve the axial skeleton but more likely to affect the hips and peripheral entheses than in adults. Many patients with juvenile SpA are at risk of developing ankylosing spondylitis during the course of their disease. Currently, the classification of SpA is approached differently in adults and in children. Using the International League of Associations for Rheumatology (ILAR) system for juvenile idiopathic arthritis, most childhood SpA is classified as enthesitis-related arthritis, but in contrast to adult SpA, the presence or a family history of psoriasis dictates a separate category of juvenile idiopathic arthritis. The ILAR system, however, does not specifically address children who are diagnosed with SpA by fulfilling the criteria for ankylosing spondylitis, those who have coexisting conditions such as inflammatory bowel disease or those with reactive arthritis. For this reason, a single diagnostic or classification system that covers the full juvenile SpA spectrum is needed. Refining the classification and diagnostic criteria of juvenile SpA will improve communication and the transition of patients from pediatric to adult clinics. It will be particularly important in the evaluation of tumor necrosis factor (TNF) inhibitors and other biological agents as indices of early axial SpA.

Key words: Ankylosing spondylitis, Enthesitis-related arthritis, Juvenile idiopathic arthritis, Psoriatic arthritis, Reactive arthritis, Spondyloarthritis.

© Archives of Hellenic Medicine