Juvenile-onset spondyloarthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesJuvenile-onset spondyloarthritisSCE Rheumatology

A 17-year-old boy has recurrent ankle arthritis, heel enthesitis and inflammatory back pain. He is HLA-B27 positive and his father has ankylosing spondylitis. MRI shows active sacroiliitis. RF and ANA are negative. What is the most likely diagnosis?

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Correct answer: E — Enthesitis-related arthritis

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · B = shown as D · A = shown as E

Enthesitis-related arthritis is best because HLA-B27-associated lower-limb arthritis, enthesitis and sacroiliitis in adolescence fit enthesitis-related arthritis. B is less suitable because systemic JIA causes quotidian fever and systemic inflammation; C is less suitable because Kawasaki disease is an acute vasculitis of childhood; D is less suitable because juvenile dermatomyositis causes rash and muscle weakness; E is less suitable because oligoarticular JIA usually affects young girls and is ANA-associated. Clinical pearl: juvenile SpA may first present as enthesitis-related arthritis before adult axial disease is established.

Reference: ILAR JIA classification; NICE NG65