What are the main symptoms?
Juvenile spondyloarthropathies have common clinical characteristics:
Arthritis
1) Most common symptoms include joint pain and swelling, and limited mobility of the joints.
2) Many children have oligoarthritis of the lower limbs. Oligoarthritis means that the disease involves four or less joints. Those developing chronic disease may have polyarthritis. Polyarthritis means that the articular involvement is more extensive and affects five or more joints.
3) Arthritis mainly involves the joints of the lower limbs: the knee, the ankle, the mid-foot, and the hips. Less frequently, arthritis involves the small joints of the foot.
4) Some children may have arthritis of any joint of the upper limbs, particularly the shoulders.
Enthesitis
Enthesitis, the inflammation of the enthesis (the site where a tendon or ligament attaches to the bone) is very frequent in children with spondyloarthropathies. Commonly affected entheses are located at the heel, in the mid-foot and around the kneecap. Most common symptoms include heel pain, mid-foot pain and swelling, and kneecap pain.
Chronic inflammation of the enthesis may lead to bony spurs (bony overgrowth). These spurs occur particular in the heel causing heel pain.
Sacroiliitis
It is the inflammation of the sacroiliac joint, located in the rear of the pelvis. It is rare at onset and most frequently occurs five to 10 years after the onset of arthritis.
The most common symptom is alternating buttock pain.
Lumbar pain; spondylitis
Involvement of the spine is very rare at onset, but may occur later in the disease course. The most common symptoms include low back pain, morning stiffness, and reduced mobility. Low back pain is frequently accompanied by neck and chest pain.
In the spine, long-term disease may cause the formation of bridges between the spinal bones (“bamboo spine”). This occurs in only few patients and after a long disease duration. It is, therefore, almost never observed in children.
Eye involvement
Acute anterior uveitis is an inflammation of the iris of the eye. It is not frequent. The eye is acutely red and painful. Immediate control by the ophthalmologist (the eye doctor) is necessary.
Skin involvement
A small subset of children with spondyloarthropathy may have psoriasis Psoriasis is a chronic skin disease with patches of scaling skin mainly located on the elbows and the knees. The skin disease may precede arthritis by years. In other patients the arthritis can already exist several years before a first psoriasis spot occurs.
Bowel involvement
Some children with intestinal inflammatory disorders may develop a spondyloarthropathy.
Inflammatory bowel disease (IBD) is used to designate chronic bowel inflammation of unknown origin. These diseases are called Crohn’s disease or ulcerative colitis.
