Psoriatic arthritis (PA): a clinical, immunological and radiological study of 180 patients. A short-term follow-up of enthesitis and arthritis in the active phase of juvenile onset spondyloarthropathies. Benefit of fluoroscopically guided intraarticular, long-acting corticosteroid injection for subtalar arthritis in juvenile idiopathic arthritis Trends in prescription of biological agents and outcomes of juvenile idiopathic arthritis: results of the Dutch national Arthritis and Biologics in Children Register Daily pain and symptoms in children with polyarticular arthritis. Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. A Randomized, Double‐Blind, Placebo‐Controlled Multicenter Study of Adalimumab in Pediatric Patients With Enthesitis‐Related Arthritis Patterns of pain over time among children with juvenile idiopathic arthritis Studies with an enthesis index as a method of clinical assessment in ankylosing spondylitis. Complete control of disease activity and remission induced by treatment with etanercept in juvenile idiopathic arthritis. Intra-articular steroids in pauciarticular juvenile chronic arthritis, type 1 Incidence and Prevalence of Juvenile Idiopathic Arthritis Among Children in a Managed Care Population, 1996–2009 Clinical responsiveness of self-report functional assessment measures for children with juvenile idiopathic arthritis undergoing intraarticular corticosteroid injections. Prevention of nonadherence to nonsteroidal anti-inflammatory medications for newly diagnosed patients with juvenile rheumatoid arthritis. Factors affecting the efficacy of intraarticular corticosteroid injection of knees in juvenile idiopathic arthritis. A comparison of three treatment strategies in recent onset non-systemic Juvenile Idiopathic Arthritis: initial 3-months results of the BeSt for Kids-study Tailored approach to early psoriatic arthritis patients: clinical and ultrasonographic predictors for structural joint damage
We carried out a prospect i ve study of the clinical , laboratory and radiological features of 180 patients with psoriatic arthritis . We initially classified our patients into five groups as described in the publications of Moll and Wright . Thirty-seven per cent had oligoarthritis , 36 % polyarthritis , 23 % spondarthritis ( sacroiliitis and /or spondylitis ) and 4 % had the mutilans form . The distal joint arthritis type did not exist as an entity and the distal interphalangeal ( DIP ) joints were affected in all groups . The spondarthritis form includes patients with exclusively axial manifestations and also those who in addition have peripheral arthritis ( oligoarthritis , polyarthritis , DIP arthritis ) . Only 53 % of our patients had nail involvement . We found an increase of IgA levels in patients with axial disease . This suggests a relationship between ankylosing spondylitis and psoriatic spondylitis . The HLA-B17/Cw6 association increased in the oligoarticular form . The increase of antigen B17 correlated with the spondarthritic and oligoarthritis forms whereas Cw6 was more important in the oligoarthritis form . An increase of the HLA-B27/Cw1 association and the spondarthritic form was also found . Moreover , we detected a greater incidence of the HLA-B27 antigen in patients with bilateral sacroiliitis ( 85 % ) than in patients with unilateral sacroiliitis ( 22 % ) . Our work revealed that PA is not a harmless disease ; 57 % of our patients had erosive arthritis while 19 % had ARA class III or IV functional impairment OBJECTIVE To describe the characteristics of enthesitis and arthritis in the active inflammatory stage of juvenile onset spondyloarthropathies ( SpA ) during a short-term follow-up . PATIENTS AND METHODS The study group included data of 33 patients with juvenile-onset SpA with enthesitis in > or = 3 sites , arthritis in > or = 4 joints , and erythrocyte sedimentation rate ( ESR ) of > or = 25 mm/h despite treatment , who participated in a 26-week , double-blind , sulfasalazine versus placebo trial that showed no significant differences between groups in regard to enthesitis and arthritis . RESULTS Twenty-seven boys and 6 girls ( mean age : 15.3 + /- 3.5 years ; mean disease duration : 4.1 + /- 2.7 years ) with the seronegative enthesopathy and arthropathy ( SEA ) syndrome ( n = 20 ) or ankylosing spondylitis ( AS ; n = 13 ) comprised the group . Throughout the study , the mean ( + /- SD ) number of swollen joints and tender entheses were 4.6 + /- 2.5 and 8.3 + /- 5.4 . The entheses and joints most frequently involved were the calcaneal attachments of the plantar fascia ( 87.9 % ) and Achilles tendon ( 81.8 % ) and the ankle ( 87.9 % ) and knee ( 72.7 % ) , respectively . There was pain in the cervical , thoracic , and lumbar spine in 39.4 % , 69.7 % , and 63.6 % of patients and in the sacroiliac joints in 48.5 % . Mid-foot involvement ( or tarsitis ) occurred in 29 patients ( 87.9 % ) . Except for the feet , the simultaneous occurrence of enthesitis and arthritis in other sites was rare . Overall , there were no significant differences between SEA syndrome and AS patients . CONCLUSIONS Disease activity shows a significant trend for entheses and joints of the feet and a significant prevalence of axial enthesitis in juvenile onset SpA. Mid-foot involvement appears to be the most characteristic and potentially , the most severe form of disease in these patients Background Children with arthritis may endure a lifetime of disfigurement , dysfunction , and pain if acute inflammation progresses to chronic changes in the joint cartilage and underlying bone . Intraarticular steroids have become an integral component of treatment , but at times are difficult to deliver to joints , such as the subtalar joint , that have complex anatomies . Objective We describe our technique and outcomes using fluoroscopically guided intraarticular subtalar steroid injection in patients with active symptoms of juvenile idiopathic arthritis ( JIA ) . Material s and methods Fluoroscopically guided subtalar joint injections were performed in 38 children ( mean age 6.7 years ) . Medical records were review ed retrospectively and improvement was evaluated clinical ly by the degree of foot movement in eversion and inversion . Results Subtalar joint injection was technically successful in 100 % of the JIA patients with improvement in physical symptoms in 34/38 ( 89 % ) . Of the 38 children , 32 were followed up within 13 weeks of the initial injection and , therefore , satisfied the eligibility criteria for resolution of arthritis . Of these 32 children , 14 showed clinical resolution ( 44 % ) . The mean duration of improvement was 1.2 ± 0.9 years . Children with a longer interval ( > 1 year ) from diagnosis to treatment had significantly less resolution ( P = 0.04 ) . Local subcutaneous atrophy or hypopigmentation were observed in 53 % of the children after steroid injection ( 20/38 ) . These minor complications were associated with a greater volume of steroid injected into the site per child ( P = 0.02 ) . Conclusion Fluoroscopically guided subtalar joint injection is an effective treatment for subtalar arthropathy . Prompt referral for intraarticular steroid treatment in the acute phase improves response . Skin changes often occur at the injection site , and specific pre caution s should be employed to reduce this risk . Prospect i ve study is indicated to determine the most effective treatment strategy to prevent long-term pain and disability Background Treatment of  juvenile idiopathic arthritis ( JIA ) has changed dramatically since the introduction of biological agents in 1999 . Objective To evaluate trends in prescription patterns of biological agents and the subsequent outcome of JIA . Methods The Arthritis and Biologics in Children register ( multicentre prospect i ve observational study ) aim ed to include all consecutive patients with JIA in the Netherl and s who had started biological agents since 1999 . Patients were divided according to year of introduction of first biological agent . Patient characteristics at introduction of the first biological agent and its effectiveness were analysed over 12 years . Results 335 patients with non-systemic JIA and 86 patients with systemic JIA started a biological agent between 1999 and 2010 . Etanercept remained the most often prescribed biological agent for non-systemic JIA ; anakinra became first choice for systemic JIA . The use of systemic glucocorticoids and synthetic disease-modifying antirheumatic drugs before biological agents decreased . During these 12 years of observation , biological agents were prescribed earlier in the disease course and to patients with lower baseline JADAS ( Juvenile Arthritis Disease Activity Score ) disease activity . All baseline disease activity parameters were lowered in patients with non-systemic JIA . In systemic JIA , prescription patterns changed towards very early introduction of biological agents ( median 0.4 years of disease duration ) in patients with a low number of joints with active arthritis and high erythrocyte sedimentation rates . These changes for both systemic and non-systemic JIA result ed in more patients with inactive disease after 3 and 15 months of treatment . Conclusions Biological agents are increasingly prescribed , earlier in the disease and in patients with JIA with lower disease activity . These changes are accompanied by better short-term disease outcomes OBJECTIVE To analyze patterns of daily pain , stiffness , and fatigue related to juvenile arthritis ; to examine the relationships of demographics , disease severity , and psychological adjustment to daily disease symptoms ; and to examine daily disease symptoms as predictors of reduced participation in school and social activity . METHODS For a 2-month period , 41 children with polyarticular juvenile arthritis completed daily diaries that included measures of symptoms and function . Children also underwent an initial evaluation and 4 followup evaluations that included a joint count , laboratory testing , and completion of question naires assessing physical and psychosocial functioning . RESULTS Children reported having pain an average of 73 % of days , with the majority of children ( 76 % ) reporting pain on > 60 % of all days . On average , children described the intensity of their daily pain as being in the mild to moderate range ; however , a significant subgroup ( 31 % ) reported pain in the severe range . Higher physician global assessment ratings , increased functional disability , and increased anxiety were significantly associated with increased daily pain and other daily symptoms . Multilevel r and om-effects analyses indicated that increased daily symptoms of pain , stiffness , and fatigue were significant predictors of reduced participation in school and social activities . CONCLUSION Physicians should consider treating pain more aggressively in children with arthritis , in order to preserve function in school and social domains , as well as physical function . Moreover , optimal pain management in children with arthritis should include therapeutic regimens addressing anxiety as well as st and ard pharmacologic interventions OBJECTIVE To develop preliminary criteria for inactive disease and clinical remission for select categories of juvenile idiopathic arthritis ( JIA ) , and to decide what such clinical states should predict in terms of probability of disease recurrence . METHODS A Delphi serial question naire consensus-formation approach was used initially to gather criteria in use by pediatric rheumatologists ( PR ) for defining clinical remission in oligoarticular ( persistent and extended ) , rheumatoid factor ( RF ) positive and negative polyarticular , and systemic JIA . Results from sequential question naires provided an agenda for a nominal group technique ( NGT ) conference to reach consensus on unresolved questions . RESULTS One hundred and thirty PR from 34 countries responded to the question naires and 20 PR from 9 countries attended the conference . Draft criteria for inactive disease include the following : no active arthritis ; no fever , rash , serositis , splenomegaly , or generalized lymphadenopathy attributable to JIA ; no active uveitis ; normal erythrocyte sedimentation rate or C-reactive protein ; and a physician 's global assessment of disease activity rated at the best score possible for the instrument used . According to consensus vote , 6 continuous months of inactive disease on medication defines clinical remission on medication , while 12 months of inactive disease off all anti-arthritis ( and anti-uveitis ) medications defines clinical remission off medication . The finalized criteria for remission off medication ideally should predict that a patient has < /= 20 % probability of disease recurrence within the next 5 years . CONCLUSION Using consensus formation techniques , we formulated preliminary criteria for inactive disease and clinical remission on and off medication for use in select categories of JIA . Retrospective validation is in progress ; prospect i ve validation will follow . Future efforts will include other categories of JIA Enthesitis‐related arthritis ( ERA ) is a juvenile idiopathic arthritis ( JIA ) category , primarily affecting entheses and peripheral joints . This study evaluated efficacy , safety , and pharmacokinetics of adalimumab versus placebo in patients with ERA Objectives Pain is a very common symptom of juvenile idiopathic arthritis ( JIA ) . Disease activity alone can not explain symptoms of pain in all children , suggesting other factors may be relevant . The objectives of this study were to describe the different patterns of pain experienced over time in children with JIA and to identify predictors of which children are likely to experience ongoing pain . Methods This study used  longitudinal- data from patients ( aged 1–16 years ) with new-onset JIA .  Baseline and up to 5-year follow-up pain data from the Childhood Arthritis Prospect i ve Study ( CAPS ) were used . A two-step approach was adopted . First ,  pain trajectories  were modelled using a discrete mixture model . Second , multinomial logistic regression was used to determine the association between variables and trajectories . Results Data from 851 individuals were included ( 4 years , median follow-up ) . A three-group trajectory model was identified : consistently low pain ( n=453 ) , improved pain ( n=254 ) and consistently high pain ( n=144 ) . Children with improved pain or consistently high pain differed on average at baseline from consistently low pain . Older age at onset , poor function/disability and longer disease duration at baseline were associated with consistently high pain compared with consistently low pain . Early increases in pain and poor function/disability were also associated with consistently high pain compared with consistently low pain . Conclusions This study has identified routinely collected clinical factors , which may indicate those individuals with JIA at risk of poor pain outcomes earlier in disease . Identifying those at highest risk of poor pain outcomes at disease onset may enable targeted pain management strategies to be implemented early in disease thus reducing the risk of poor pain outcomes The histopathological characteristic of ankylosing spondylitis ( AS ) is the presence of chronic enthesitis . Our aim was to develop a clinical measurement of the severity of tenderness over entheses . The scoring system was based on the patients ' response to palpation over entheses easily accessible to examination . The enthesis index ( EI ) correlated with pain ( r = 0.67 , p less than 0.01 ) and stiffness ( r = 0.46 , p less than 0.05 ) scores . A single , blind , crossover study was conducted to determine the sensitivity of the index to change in clinical state associated with non-steroidal antirheumatic drug therapy and to record the interobserver variability . The index showed significantly lower scores after one week 's drug treatment ( p less than 0.05 ) . The EI is a convenient , non-invasive measure of disease severity in patients with AS . Potential applications include the assessment of enthesitis in other polyarthritides and a means of distinguishing clinical ly between severity of enthesitis and synovitis in different types of polyarthritis OBJECTIVES To identify contributing factors associated with inactive disease ( ID ) and clinical remission for patients with juvenile idiopathic arthritis ( JIA ) treated with etanercept .  METHODS Data of an ongoing , long-term , multicentre , prospect i ve , open-label observational study were analysed . Results . A total of 4898 follow-up forms from 787 JIA patients treated with etanercept were evaluated . Sixty-four per cent of the patients were female , 75 % concomitantly received MTX and 45.9 % received corticosteroids . Until the last observation , 47.6 % of patients reached the criteria for ID and 26.6 % achieved the remission on medication criteria . For both , ID and remission on medication , a significant influence of shorter disease duration ( P<0.01 and P<0.001 ) , a weekly dosage of at least 0.8 mg/kg ( P=0.02 ) , lower active joint counts ( P=0.001 ) and lower childhood HAQ score ( P<0.001 and P=0.004 ) at baseline was found . The odds ratio ( OR ) for a girl 's chance to reach ID was 0.73 ( P=0.049 ) and for remission on medication was 0.68 ( P=0.04 ) compared with boys . The concomitant administration of MTX raised the relative chance , especially in patients with seronegative polyarthritis ( OR 2.0 ; P=0.03 ) . CONCLUSION Upon treatment with etanercept , many JIA patients reached ID and remission on medication , although they had suffered from long-st and ing , refractory disease . Earlier initiation of treatment , less severe disease , use of at least the recommended weekly dosage of etanercept , and concomitant treatment with MTX seemed to independently increase the chance for reaching remission . These data should be confirmed by controlled prospect i ve studies The use of intra-articular steroids in one or both knees was evaluated in 21 children with type 1 pauciarticular juvenile chronic arthritis ( JCA ) . The beneficial effect of the injection was noted within 3 days with no significant adverse reactions . Remission exceeding 6 months was seen in 70 % of the knees and the arthritis remained inactive during the follow up period in 37 % . The beneficial effect of the injection did not correlate with sex , age of onset or the presence of antinuclear antibodies or HLA-B27 antigen and there was no relationship with the size of involved joints at onset , the ESR at onset , or the presence of uveitis . Intra-articular corticosteroids in this type of JCA may provide prompt relief of swelling and pain and reduce the need for other forms of therapy . Remission was long lasting in the majority of the children Objective . Few studies based in well-defined North American population s have examined the occurrence of juvenile idiopathic arthritis ( JIA ) , and none has been based in an ethnically diverse population . We used computerized healthcare information from the Kaiser Permanente Northern California membership to vali date JIA diagnoses and estimate the incidence and prevalence of the disease in this well-characterized population . Methods . We identified children aged ≤ 15 years with ≥ 1 relevant International Classification of Diseases , 9th edition , diagnosis code of 696.0 , 714 , or 720 in computerized clinical encounter data during 1996–2009 . In a r and om sample , we then review ed the medical records to confirm the diagnosis and diagnosis date and to identify the best-performing case-finding algorithms . Finally , we used the case-finding algorithms to estimate the incidence rate and point prevalence of JIA . Results . A diagnosis of JIA was confirmed in 69 % of individuals with at least 1 relevant code . Forty-five percent were newly diagnosed during the study period . The age- and sex-st and ardized incidence rate of JIA per 100,000 person-years was 11.9 ( 95 % CI 10.9–12.9 ) . It was 16.4 ( 95 % CI 14.6–18.1 ) in girls and 7.7 ( 95 % CI 6.5–8.9 ) in boys . The peak incidence rate occurred in children aged 11–15 years . The prevalence of JIA per 100,000 persons was 44.7 ( 95 % CI 39.1–50.2 ) on December 31 , 2009 . Conclusion . The incidence rate of JIA observed in the Kaiser Permanente population , 1996–2009 , was similar to that reported in Rochester , Minnesota , USA , but 2 to 3 times higher than Canadian estimates OBJECTIVE The Childhood Health Assessment Question naire ( CHAQ ) , Juvenile Arthritis Functional Assessment Report ( JAFAR ) , and Juvenile Arthritis Functional Status Index ( JASI ) are widely used functional measures for juvenile idiopathic arthritis ( JIA ) that differ in content , format , and completion time . We compared the responsiveness and child-parent agreement of the JAFAR , CHAQ , and JASI in a prospect i ve , multicenter study . METHODS Children and adolescents from 5 rheumatology centers were enrolled . Subjects were about to undergo therapy ( intraarticular corticosteroid injections [ IAS ] and methotrexate or hip surgery ( MTX/hip ] ) expected to produce a functional improvement . All subjects were studied before the intervention and at 6 weeks and 6 months posttreatment . At each study visit , the 3 measures were administered in r and omized , balanced order to both parents and children . RESULTS A total of 92 subjects ( mean age 12.8 years ) were enrolled in the study , 74 of which were in the IAS group . The responsiveness of all 3 measures was moderate to strong . The st and ardized response mean at 6 weeks for the IAS group on the JAFAR , CHAQ , and JASI was 0.41 ( 95 % confidence interval [ 95 % CI ] 0.18 , 0.64 ) , 0.70 ( 95 % CI 0.47 , 0.93 ) , and 0.36 ( 95 % CI 0.13 , 0.59 ) , respectively . The CHAQ was somewhat more responsive to change at 6 weeks ( IAS group : relative efficiency 0.34 [ JAFAR ] , 0.27 [ JASI ] ) , but less responsive at 6 months ( MTX/hip group : relative efficiency 5.1 [ JAFAR ] , 3.9 [ JASI ] ) . All 3 question naires showed acceptable parent-child agreement , and overall , there were few differences between the 3 question naires . CONCLUSION The functional outcome measures currently used for JIA are all adequately responsive for use in trials or in the clinic setting . The choice of which measure to use should therefore be based on the time available for completion , the intended clinical / research use , and the depth of content required Adherence to medications for chronic pediatric diseases decreases overtime . This r and omized controlled trial evaluated a clinic-based , nurse-administered educational and behavioral intervention to prevent the anticipated drop in adherence to nonsteroidal medications among newly diagnosed patients with juvenile rheumatoid arthritis . Thirty-four participants completed the study ( mean age = 8.44 years , SD = 3.96 ) , including 19 in the experimental group and 15 in the st and ard-treatment ( education ) control group . There were significant group and Group x Time effects for adherence ( assessed with an electronic monitor over a 13-month period ) favoring the experimental group . In contrast , the groups did not differ significantly in disease activity or functional limitations . Factors that may have prevented detection of differences in these health parameters are dicussed OBJECTIVE To determine in a prospect i ve analysis whether baseline demographic , clinical , and laboratory variables predict the outcome of intraarticular corticosteroid ( IAC ) injection of the knees in children with juvenile idiopathic arthritis ( JIA ) . METHODS We studied consecutive patients who met the criteria for the diagnosis of JIA and received their initial injection of triamcinolone hexacetonide in one or both knees .  Predictor variables included sex , age , age at onset of JIA , onset subtype , disease duration , drug therapy at the time of IAC injection , physician and parent global assessment of disease status , Childhood Health Assessment Question naire disability index , erythrocyte sedimentation rate ( ESR ) , C-reactive protein , involvement of other joints besides knees , amount of fluid aspirated , and dose of IAC injected . The primary outcome measure was persistence of complete clinical response at 6 months , i.e. , no evidence of synovitis clinical ly . RESULTS Ninety-four patients were available for analysis . At 6 months after the IAC injection , 65 ( 69 % ) patients showed a sustained complete clinical response , whereas 29 ( 31 % ) had had a recurrence of joint inflammation . Univariate statistical analyses showed that patients who had a sustained clinical response had a significantly higher ESR than those who did not ( p = 0.023 ) . The ESR was the only variable that remained in the best-fit model from multivariate logistic regression analysis ( OR 2.61 , p = 0.049 ) . CONCLUSION Our findings indicate that patients with JIA who have a higher ESR are more likely to benefit from IAC injection of the knees Background Combination therapy with prednisone or etanercept may induce earlier and /or more improvement in disease activity in Disease Modifying Anti Rheumatic Drug ( DMARD ) naïve non-systemic Juvenile Idiopathic Arthritis ( JIA ) patients . Here we present three months clinical outcome of initial treatments of the BeSt-for-Kids study . Methods Included patients were r and omized to either : 1 . initial DMARD-monotherapy ( sulfasalazine ( SSZ ) or methotrexate ( MTX ) )  , 2 . Initial MTX / prednisolone-bridging  , 3 . Initial combination MTX/etanercept . Percentage inactive disease , adjusted ( a ) ACR Pedi30 , 50 and 70 and JADAS after 6 and 12 weeks of treatment ( intention to treat analysis ) and side effects are reported . Results 94 patients ( 67 % girls , 32 ( arm 1 ) , 32 ( arm 2 ) and 30 ( arm 3 ) with median ( InterQuartileRange ) age of 9.1 ( 4.7 - 12.9 ) years were included . 38 % were ANA positive , 10 had oligo-articular disease , 68 polyarticular JIA and 16 psoriatic arthritis . Baseline median ( IQR ) ACRpedi-scores : VAS physician 49 ( 40 - 58 ) mm , VAS patient 54 ( 37 - 70 ) mm , ESR 6.5 (2 - 14.8)mm/hr , active joint count 8 ( 5 - 12 ) , limited joint count 3 ( 1 - 5 ) , CHAQ score 0.88 ( 0.63 - 1.5 ) . In arm 1 , 17 started with MTX , 15 with SSZ.After 3 months , aACR Pedi 50 was reached by 10/32 ( 31 % ) , 12/32(38 % ) and 16/30 ( 53 % ) ( p = 0.19 ) and aACR Pedi 70 was reached by 8/32 ( 25 % ) , 6/32(19 % ) and 14/30(47 % ) in arms 1 - 3 ( p = 0.04 ) . Toxicity was similar . Few serious adverse events were reported . Conclusion After 3 months of treatment in a r and omized trial , patients with recent-onset JIA achieved significantly more clinical improvement ( aACRPedi70 ) on initial combination therapy with MTX / etanercept than on initial MTX or SSZ monotherapy . Trial registration NTR1574 . Registered 3 December 2008 This study aims to identify the clinical predictors of arthritis in patients with psoriasis and to evaluate the use of musculoskeletal ultrasonography ( US ) as a predictor for inflammatory structural progression in psoriatic patients .  Measures of association ( odds ratio ( OR ) ) were tested , in a prospect i ve , cohort 1-year follow-up study , between structural deterioration and the presence of baseline inflammation , or its persistence . One hundred twenty-six psoriatic patients were prospect ively evaluated both clinical ly and by US at 0 , 6 , and 12 months for synovitis/ joint damage , enthesitis , and onychopathy . X-ray was performed at 0 and 12 months . One hundred twelve sex and age-matched pasoriatic patients without histories of musculoskeletal symptoms were included as control group .  Structural deterioration was observed in 47 % of the 5,292 evaluated joints . Clinical variables associated with arthritis risk : BMI > 25 ( OR = 1.7 ) , body surface area ( OR = 1.13 ) , family history ( OR = 5.72 ) and nail involvement ( OR = 2.25 ) . BMI > 30 was significantly correlated ( P < 0.01 ) with shorter time for the onset of arthritis . Baseline synovial score/PD score ≥ 2 was associated with increased risk of structural progression : OR = 1.98 versus 2.61 versus 2.66 ( P < 0.001 ) for the clinical versus US-gray scale ( GS ) versus US-power Doppler ( PD ) evaluation , respectively . An increased probability for structural progression in the presence of enthesitis was observed ( OR = 2.79 and 3.50 ) for both US-GS and US-PD , whereas OR was 2.46 for clinical examination . Onychopathy was associated with structural joint damage ( OR = 2.30 ) . In multivariate logistic regression analysis , persistent of synovitis/enthesitis at 6 months of therapy was predictive of subsequent structural progression . Family history of psoriatic arthritis , large BMI ( > 25 ) , high percentage of psoriatic body surface area , and nail involvement were significantly associated with early onset psoriatic arthritis . Baseline GS score of ≥2 , PD score of ≥2 , presence of enthesitis , enhanced vascularity at enthesitis , higher GUESS score , and onychopathy , all at base line as well as persistent synovitis and enthesitis at 6 months are predictors of progressive early psoriatic arthritis . Regular ultrasonographic monitoring of these patients is m and atory to assess the progression of their arthritis status
Good disease control , with therapeutic escalation to achieve low disease activity , was recommended .
OBJECTIVE To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis , sacroiliitis , or enthesitis .