Sacroiliitis in early ERA

描述（由申请人提供）：幼年特发性关节炎（JIA）是儿童时期最常见的风湿性疾病，每1,000名儿童中有1至4人患病。附着点炎相关关节炎（ERA）和银屑病关节炎（PsA）分别占JIA的约20%和10%。ERA和PsA的特征是下肢附着点炎和中轴和外周骨骼关节炎。患有这两种疾病的儿童也有患骶髂关节炎或骶髂关节炎症的风险。如果不及时治疗，骶髂关节炎可能发展为脊柱炎，其特征是影像学表现为成方形、糜烂、韧带赘生物、椎间盘炎和中轴关节融合。在横断面研究中，分别有44%和30%的ERA和PsA儿童有骶髂关节炎的临床或影像学证据。诊断时ERA和PsA儿童骶髂关节炎的患病率尚不清楚。骶髂关节炎的早期识别和积极治疗可能是改变疾病进程的机会。如果ERA/PsA发作时可检测到临床前骶髂关节炎 那么立即用抗TNF药物治疗可能会改变骶髂关节炎的病程，并极大地影响受累儿童和青少年的功能和生活质量。拟定的研究计划旨在确定新诊断ERA或PsA的儿童和青少年中骶髂关节炎（通过MRI定义）的患病率，并评估体格检查和炎性背痛史检测儿童和青少年骶髂关节炎的准确性。本申请中提出的研究将为候选人提供关于前瞻性患者导向研究中儿童招募和入组的初步数据，以及两项相互关联的ERA/PsA研究的实施、开展和分析。候选人预计该项目将为开发和支持额外R 01校外资金的应用奠定基础，以：1）进一步研究在儿科ERA和PsA的临床实践和试验中疾病发作时骶髂关节炎的诊断和预测价值;（二）研究全身MRI在诊断ERA或PsA儿童额外中轴骨骼病变时的作用，诊断;和3）进行前瞻性药物流行病学和比较有效性研究，治疗小儿ERA和PsA骶髂关节炎。

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.