enthesitis affecting the spine and sacroiliac joints. Spodyloarthropathies are more common in boys and are frequently associated with the genetic marker HLA-B27. Spine and sacroiliac joint involvement is more common in the juvenile idiopathic arthritis subtype Enthesitis Related Arthritis (ERA) than other childhood arthritides, but axial disease is often a late manifestation. Reactive arthritis, psoriatic arthritis and inflammatory bowel disease may also present with spondyloarthropathy. Children may present with back or buttock pain but the typical history of morning stiffness, gradual resolution of pain with activity and clinical exam findings of limited lumbar mobility (Schober test), sacroiliac joint tenderness and peripheral enthesitis or arthritis usually allow the practitioner to make the correct diagnosis [ 10 ]. A complete joint and systemic examination to exclude other joint involvement is important. Radiographs of the lumbar spine and SI joints are often normal early in disease but widening of the joint, sclerosis and erosions may be apparent. MRI with gadolinium may delineate early inflammatory change. Treatment of arthritis includes physiotherapy for improving range of motion and strength, NSAIDs, disease modifying anti-rheumatic therapy, or biologic therapy. All children and adolescents suspected of having inflammatory arthritis should be referred to a pediatric rheumatologist. Pain amplification syndromes Many pediatric patients with severe chronic musculoskeletal pain do not have an identified cause. The cause of amplified musculoskeletal pain is unknown, but minor trauma, underlying chronic illnesses and psychological distress have been associated. Typically, an affected child has pain at multiple sites in addition to back pain. On