Sacroiliitis in early ERA

描述(申请人提供)：幼年特发性关节炎(JIA)是儿童时期最常见的风湿病，每1000名儿童中就有1至4名患病。末端炎性关节炎(ERA)和银屑病关节炎(PSA)分别约占JIA的20%和10%。Era和PSA的特征是下肢的肌腱端炎和轴骨和外周骨骼的关节炎。患有这两种情况的儿童也有发展为骶髂炎或骶骨关节炎症的风险。如果不进行治疗，腰椎炎可能会进展为脊柱炎，这种情况的特征是放射学表现为方形、侵蚀、关节突起、关节盘炎和轴突融合。在横断面研究中，患有ERA和PSA的儿童中，分别有多达44%和30%的儿童有临床或放射学证据表明患有骶髂炎。在诊断为ERA和PSA的儿童中，患病率尚不清楚。早期识别和积极治疗可能是改变病程的机会。在ERA/PSA发病时是否可检测到临床前骶髂炎 那么，立即使用抗肿瘤坏死因子药物治疗可能会改变骶髂炎的病程，并极大地影响受影响的儿童和青少年的功能和生活质量。拟议的研究计划旨在确定在新诊断为ERA或PSA的儿童和青少年中，根据MRI的定义，SAI的患病率，并评估体检和炎症性背痛病史在儿童和青少年中检测SAI的准确性。这项申请中提出的研究将为候选人提供关于招募和登记儿童参加预期的以患者为导向的研究的初步数据，以及两项相互关联的ERA/PSA研究的实施、实施和分析。候选人期望该项目将为开发和支持额外R01外部资金的申请奠定基础，以：1)在儿科ERA和PSA的临床实践和试验中进一步调查起病时SAI的诊断和预测价值；2)调查全身MRI在诊断时检测ERA或PSA儿童额外轴骨病变的作用；以及3)进行前瞻性药物流行病学和比较有效性研究，以治疗儿科ERA和PSA的SAI。 公共卫生相关性：包括生物制剂在内的新药物彻底改变了青少年特发性关节炎(JIA)的治疗方法并改善了长期结果，包括JIA的两个类别--末端炎症性关节炎(ERA)和牛皮癣 关节炎(PSA)。这项拟议的研究旨在确定患有ERA和PSA的儿童和青少年有发展成脊柱炎的风险，这会导致长期的发病率和功能障碍，以及谁可能从这些新疗法的早期治疗中受益。这一研究项目将为开发和支持额外外部资金的申请奠定基础，以用于未来的干预研究，这些研究将极大地影响患有各种形式JIA的儿童和青少年的功能和生活质量。

DESCRIPTION (provided by applicant): Juvenile idiopathic arthritis (JIA) is the most commonly diagnosed rheumatic disease in childhood, affecting 1 to 4 per 1,000 children. Enthesitis-related arthritis (ERA) and psoriatic arthritis (PsA) account for approximately 20% and 10% of JIA, respectively. ERA and PsA are characterized by enthesitis of the lower extremities and arthritis of the axial and peripheral skeleton. Children with these 2 conditions are also at rik of developing sacroiliitis, or inflammation of the sacroiliac joints. Left untreated, sacroiliitis ay progress to spondylitis, a condition characterized by radiographic findings of squaring, erosions, syndesmophytes, diskitis, and fusion of the axial joints. In cross-sectional studies as many as 44% and 30% of children with ERA and PsA, respectively, have clinical or radiographic evidence of sacroiliitis. The prevalence of sacroiliitis in children with ERA and PsA at the time o diagnosis is unknown. Early identification and aggressive treatment of sacroiliitis may be an opportunity to alter the disease course. If pre-clinical sacroilitis is detectable at ERA/PsA onset then immediate treatment with anti-TNF agents may alter the course of sacroiliitis and greatly impact the function and quality of life of affected children and adolescents. The proposed research plan is designed to determine the prevalence of sacroiliitis, as defined by MRI, in children and adolescents with newly diagnosed ERA or PsA, and to assess the accuracy of physical examination and a history of inflammatory back pain for the detection of sacroiliitis in children and adolescents. The research proposed in this application will provide the candidate with preliminary data regarding the recruitment and enrollment of children in prospective patient- oriented research, and the implementation, conduct, and analysis of two inter-related ERA/PsA studies. The candidate anticipates this project will build the foundation to develop and support applications for additional R01 extramural funding to: 1) further investigate the diagnostic and predictive value of sacroiliitis at disease onset in clinical practice and trials of pediatric ERA nd PsA; 2) investigate the role of whole body MRI at diagnosis for the detection of additional axial skeleton lesions in children with ERA or PsA at the time of diagnosis; and 3) perform prospective pharmacoepidemiology and comparative effectiveness studies for the treatment of sacroiliitis in pediatric ERA and PsA. PUBLIC HEALTH RELEVANCE: New medications, including biologic agents, have revolutionized the treatment and improved the long-term outcomes of Juvenile Idiopathic Arthritis (JIA), including the 2 JIA categories of enthesitis-related arthritis (ERA) and psoriatic arthritis (PsA). The proposed research aims to identify children and adolescents with ERA and PsA who are risk of developing spinal inflammation, which causes long-term morbidity and dysfunction, and who may benefit from early treatment with these newer therapies. This research project will build the foundation to develop and support applications for additional extramural funding to for future intervention studies that will greatly impact the function and quality of life for children and adolescents with all forms of JIA.