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Enthesitis-Related Arthritis

 Enthesitis-Related Arthritis



Enthesitis-related arthritis (ERA) is one of several types of juvenile idiopathic arthritis (JIA). These childhood autoimmune conditions begin before the child’s 16th birthday and can evolve, flare, or improve over time.

Enthesitis is the painful inflammation of the entheses, the fibrous connective tissue that attaches your tendons and ligaments to your bones. There are over 100 entheses in your body.

In ERA, your immune system mistakenly attacks both joints and entheses, leading to inflammation. Children with ERA may have swelling, pain, and stiffness of multiple joints and entheses, along with other symptoms.

Although ERA is a chronic disease, treatment can manage symptoms and even cause them to go into remission.

What are the symptoms of enthesitis-related arthritis?

Common symptoms include:

enthesitis (pain where tendons or ligaments join bones), most often at the lower part of the kneecap and the heel

arthritis (pain, swelling, and stiffness) of any joint, most often the hip, knee, ankle, shoulder, and sacroiliac joint

fever

uveitis (painful red eye, vision changes)

gut inflammation ranging from mild, nonspecific symptoms to inflammatory bowel disease

What causes enthesitis-related arthritis?

ERA and other forms of JIA are inflammatory autoimmune disorders. In these conditions, your immune system mistakenly begins attacking your own body.

In ERA, your immune system attacks your joints and entheses, causing inflammation, pain, and swelling at affected sites.

Doctors aren’t yet sure what causes the immune system to misfire. They suspect a combination of:

genetic risk factors

infections

microtrauma to the entheses

other environmental triggers

How do doctors diagnose enthesitis-related arthritis?

Your doctor will discuss your child’s symptoms and family medical history, perform a physical exam, and order blood tests. Imaging tests like X-rays, ultrasounds, or MRIs may also help.

Your child may also need to see other specialists to help diagnose and treat ERA, such as:

rheumatologist

ophthalmologist

physical therapist

What is the treatment for enthesitis-related arthritis?

If your child receives a diagnosis of ERA, you’ll see both a primary care pediatrician and a rheumatologist who specializes in immune-mediated conditions. Depending on symptoms, your child might also see an ophthalmologist, gastroenterologist, or physical or occupational therapist.

Medications help treat ERA symptoms and prevent damage to your joints. Your doctor might suggest anti-inflammatory therapies like:

nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or diclofenac

sulfasalazine

methotrexate

biologics, such as anti-TNF-alpha agents

In certain circumstances, a doctor might consider steroid injections into the joint or enthesis.

Exercise regimens encouraging stretching and flexibility, supportive shoe inserts, and ice application can also help you manage symptoms and stay active.

What is the outlook for people with enthesitis-related arthritis?

ERA is a chronic autoinflammatory disease requiring long-term monitoring and treatment. Research Trusted Source suggests that children with ERA experience more persistent problems with pain and function than those with other forms of JIA.

Children with ERA often experience evolving symptoms into adulthood. But symptom management and even complete remission are possible.

Only a few studies have explored long-term outcomes in children with ERA. One older study found that approximately 15 years after diagnosis, 44%Trusted Source of ERA patients were in remission, though long-term complications such as reduced spinal flexion were common.

Type of Doctor Department :  A rheumatologist

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