THU0321 110 patients with enthesitis related arthritis: A demographic and clinical study from a tertiary level pediatric rheumatology centre in india
Authors: M. Agarwal, M. Jariwala, S. Sawhney, R. Prakash
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> The ERA subcategory forms a major proportion of children with JIA in India (36%) (1) whereas western literature suggests ERA in JIA patients to be 6-19% (2,3). In these patients, inflammatory back pain has been suggested to occur infrequently at onset. This is not our experience. This study was taken up to systematically address these questions. <h3>Objectives</h3> 1.) To study the demographic and clinical profile of patients with ERA 2.) To compare it to the western data available <h3>Methods</h3> All data was prospectively collected on standardised proformas for all ERA patients from 2009 August to January 2012. <h3>Results</h3> <i>Demographics:</i> A total of 110 patients with ERA were seen through this period. Of these 88% (96) were boys with a median age of onset 10.79 years (range 1.63-15.83).10.9% had a positive family history of spondyloarthropathy. <i>Clinical Features at onset (as defined by clinical features seen in the first 6 months of clinical disease)</i>Peripheral joint disease seen in 87.3%, axial disease in 46.3%, enthesitis in 48.2%. Of all patients with axial disease, 4.5% had only cervical spine involvement without sacroiliitis. Of the 12.7%patients who had no peripheral joint disease; 9% had only axial disease and 3.6% had axial disease with enthesitis. Hip involvement, a poor prognostic sign, was seen in 23%.The median no. of active joint count was 3 with a strikingly high no. of patients who had a tarsus/metatarsal involvement at 33.6%. Of this cohort 95.4% were HLA B 27 positive. Uveitis was seen in 21.8%, of which 87.5% had acute anterior uveitis and 12.5% persisted with chronic uveitis. <i>Comparison with western data:</i> Only one publication by Pagnini et al from Europe described features of ERA at onset (4). In this study, of the 59 patients, 30% developed sacroiliitis a year after onset, 58% had mid foot involvement, 66% were HLA B 27 positive and this cohort comprised only 28% of the total no. of JIA patients at that centre. <h3>Conclusions</h3> This study, the first from India describes a large cohort of ERA patients who differ significantly from their western counterparts. The patients from our centre have higher proportion of HLA B 27 positivity, early onset axial and midfoot disease with paucity of positive family history. This study needs to be replicated from other centres in India. <h3>References</h3> Kunjir V, Venugopalan A, Chopra A. Profile of Indian patients with juvenile onset chronic inflammatory joint disease using the ILAR classification criteria for JIA: a community-based cohort study. The Journal of rheumatology. 2010 Aug 1;37(8):1756–1762. Demirkaya E, Ozen S, Bilginer Y, Ayaz NA, Makay BB, Unsal E, et al. The distribution of juvenile idiopathic arthritis in the eastern Mediterranean: results from the registry of the Turkish Paediatric Rheumatology Association. Clinical and experimental rheumatology;29 1):111–116. Thompson SD, Barnes MG, Griffin T a, Grom A a, Glass DN. Heterogeneity in juvenile idiopathic arthritis: impact of molecular profiling based on DNA polymorphism and gene expression patterns. Arthritis and rheumatism.2010 Sep;62(9):2611–2615. Pagnini I, Savelli S, Matucci-Cerinic M, Fonda C, Cimaz R, Simonini G. Early predictors of juvenile sacroiliitis in enthesitis-related arthritis. The Journal of rheumatology. 2010 Nov; 37(11):2395-2401. <h3>Disclosure of Interest</h3> None Declared