Enthesitis related arthritis

This is a less well known form of childhood arthritis which tends to affect boys only. It occurs in not only the joints but the areas where the tendons or ligaments connect to the bones. This may also cause stiffness in the spine especially in teenage boys.

Presentation of enthesitis related arthritis

The symptoms of enthesitis related arthritis usually occur between the ages of 9 and 12 years of age.

This condition is characterised by pain and swelling in many joints within the body which include the heel, elbow, fingers and toes. It also includes the chest and pelvis.

This condition has been associated with other forms of arthritis such as rheumatoid arthritis, osteoarthritisand reactive arthritis.

Symptoms include:

• Pain
• Swelling
• Inflammation
• Heat around the affected area

In some cases the affected joint, e.g. toe resembles a sausage due to the extent of the swelling.

Treatment of enthesitis related arthritis

This usually consists of medication such as non-steroidal anti-inflammatory drugs (NSAID’s), disease modifying anti-rheumatic drugs (DMARD’s), e.g. methotrexate and anti-TNF blockers.

Physiotherapy and occupational therapy will be recommended. These enable the child to find ways of coping with the symptoms and leading a similar life to their peers.

For boys in particular; it is important that they are mobile and get as much exercise as possible to prevent any problems with their development.

Plus it is important that they can undertake similar activities as other children even with a few modifications. Children learn quickly how to adapt. This may mean learning to alternate periods of activity, e.g. playing football with short rest periods.

Prognosis of enthesitis related arthritis

The outcome differs from one child to the next. Some children will be fortunate in that their symptoms will disappear after a short period of time.

Other children may find that their symptoms disappear only to reappear during puberty or adulthood.

A small percentage of children develop other forms of arthritis such as ankylosing spondylitis.