Entezit İlişkili Artrit Tanılı Hastaların Hastalık Şiddetlerinin ve Tedavi Yanıtlarının Değerlendirilmesi

Abstract

Aydın S. Evaluation of Disease Severity and Treatment Responses in Patients With Enthesitis-Related Arthritis. Hacettepe University Faculty of Medicine, Thesis in Pediatrics. Ankara, 2024. Enthesitis-Related Arthritis (ERA) is a subtype of Juvenile Idiopathic Arthritis (JIA) and holds a significant place among chronic rheumatic diseases in childhood. This disease, commonly seen in boys aged 10–13 years, is characterized by peripheral arthritis, enthesitis, and axial involvement. Genetic factors, particularly Human Leukocyte Antigen (HLA)-B27 positivity, alterations in gut microbiota, and mechanical stress are thought to play roles in the etiopathogenesis of ERA. However, the scarcity of studies investigating the differences between this group and adult patients, the use of disease activity indices, and the effectiveness of treatments creates significant gaps in ERA management. This study aimed to evaluate the demographic, clinical, and laboratory data of ERA patients, assess disease activity indices (Juvenile Arthritis Disease Activity Score [JADAS], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], and Juvenile Spondyloarthritis Disease Activity Index [JSpADA]), investigate treatment responses, and identify conditions requiring biological agents. In this retrospective study, clinical, laboratory, and imaging data of 133 ERA patients were analyzed. Disease activity and treatment responses were assessed using JADAS, BASDAI, and JSpADA, along with the impact of comorbidities, HLA-B27, and factors influencing biological drug use and active disease at follow-up visits. The median age at diagnosis was 13.2 years (range 6–17.4), and the median disease duration was 7.1 years (range 0.25–15.3). There was no significant association between comorbidities or HLA-B27 positivity and disease characteristics. However, comorbidities (p=0.035), axial involvement at diagnosis (p=0.042), absence of peripheral arthritis (p=0.047), and the presence of osteitis on magnetic resonance imaging (MRI) (p=0.045) were associated with increased use of biological drugs. After three months of treatment, approximately one-third of patients achieved inactive disease with non-steroidal anti-inflammatory drugs (NSAIDs), while around half achieved inactive disease with sulfasalazine (SLZ) or methotrexate (MTX). Inactive disease rates with MTX were lower compared to SLZ. Nearly 90% of patients receiving biological agents achieved inactive disease. Strong correlations were observed between JADAS, BASDAI, and JSpADA. At follow-up visits, active disease according to JADAS was associated with age at diagnosis (p=0.041) and the presence of axial involvement (p=0.02); active disease according to BASDAI was associated with current symptoms (p<0.001), axial involvement (p<0.001), and enthesitis (p=0.041); active disease according to JSpADA was associated with current symptoms (p<0.001), axial involvement (p<0.001), and elevated ESR (p=0.004). These findings indicate that disease activity indices strongly correlate with each other, NSAIDs, SLZ, and MTX provide some degree of inactive disease, and factors such as comorbidities, axial involvement at diagnosis, and osteitis on MRI are important determinants of biological drug use. Keywords: Enthesitis-Related Arthritis, BASDAI, JSpADA, NSAIDs, sulfasalazine, biological agents