Children are also susceptible to rheumatic diseases; thus, one in five patients with ankylosing spondylitis -a chronic condition that causes inflammation of the joints of the spine- and more than one in four affected by skin psoriasis, had the first manifestations of the disease before reaching the age of 16. In addition, although these pathologies sometimes resolve during childhood, it is estimated that almost half of these patients can suffer sequelae during adulthood.

For this reason, rheumatologists gathered in the IV Spondyloarthritis Symposium of the Spanish Society of Rheumatology, recently held in La Coruña, have warned of the need to improve diagnostic methods that allow early detection of these pathologies, to establish the appropriate treatment as soon as possible, and avoid injuries that may result in sequels that continue to affect them when they reach adulthood.

Nowadays, fortunately, image tests are available such as magnetic resonance and the musculoskeletal ultrasound, which allow early diagnosis of these diseases.

The role of genetics

The juvenile spondyloarthritis they are a set of diseases that begin before the age of 16, whose highest prevalence occurs in children as of six years of age, and which are strongly linked to the HLA-B27 antigen (which is found in 60-90 percent of cases).

At present, its causes are not known, but the investigations carried out associate them with a genetic factor. The experts also point out a probable relationship with some childhood infections, especially of the digestive system and, to a lesser extent, genito-urinary tract infections; as well as with an abnormal immune response in a genetically predisposed person.

Improvement of treatments

The pharmacological treatment must be completed with the practice of exercises aimed at maintaining joint mobility and the acquisition of adequate postural habits

The biological drugs they constitute the main novelty with respect to the treatments of autoimmune rheumatic diseases, both in adults and in the child population, since anti-TNFs can also be administered to children.

It is important that the pharmacological treatment be completed with other measures such as the practice of physical exercises aimed at maintaining joint mobility, and the acquisition of appropriate postural habits. This, in the case of children, involves an effort on the part of the people who are part of their environment (parents and the rest of the family or personnel in charge of their care, educators, friends, health professionals ...).

Study of SER

The Spanish Society of Rheumatology (SER) and the Mexican Society of Rheumatology, have begun an investigation, called MexEspa, with which they intend to identify early predictive factors of poor prognosis in children suffering from spondyloarthritis, and observe its evolution in five years (from the first visit to the specialist).

To carry out this initiative, they have selected some 180 children with juvenile spondylitis, who will undergo an exhaustive control every six months, in order to detect factors related to the evolution of the disease, such as genetic, socio-health factors , the manifestations present at the beginning of the condition, among others.

Source: Spanish Society of Rheumatology (SER)

"Acute Rheumatic Fever" by Emmanuel Rusingiza, MD, for OPENPediatrics (November 2019).