I113. Adolescent-Onset Spondyloarthropathies and Enthesitis Related Arthritis: Current Understanding of Pathophysiology, Management and Prognosis as Patients Enter Early Adulthood

Abstract

Adolescence is a distinct developmental stage of young people (YP) aged between 10 and 19. It is a time of tumultuous change characterized by complex neurocognitive development that continues into the mid-20s-so called emerging or early adulthood. Traditional healthcare divisions characterize paediatric rheumatology as concerned with patients up to mid/late adolescence (usually 16-18) with adult rheumatology seeing patients thereafter. Transitional medicine and adolescent rheumatology seek to bridge the resulting potential gap in care for adolescents and young adults (AYA) and rheumatology leads in this area. The artificial divide between paediatric and adult rheumatology specialities leads both to knowledge gaps (e.g. for adult rheumatologists seeing patients with JIA) but also to the potential for knowledge sharing. This is particularly pertinent in the rapidly evolving areas both of SpA diagnosis, imaging and management and current understandings of enthesitis. JIA is an umbrella term describing several subsets of joint disease in YP under 16 with 30-50% having continued arthritis into later adolescence and into adulthood. The natural history and pathophysiology of adolescent-onset SpA/enthesitis related JIA (ERA-JIA) are relatively uncharacterized, but peripheral arthritis (including severe hip disease) is the usual presenting feature with axial disease occurring later in adolescence or early adulthood. Clinical experience in adolescent rheumatology suggests that the YP with ERA-JIA often present relatively late, require biologic therapy, have high levels of pain and functional disability with disease usually continuing into adulthood. Ensuring patient engagement with healthcare services during adolescence (where risk-taking behaviours including non-adherence with medical care are normal) is a particular challenge in this group relevant to adult and paediatric rheumatologists alike. This challenge must be met since the paradigm that early recognition and treatment of arthritis are essential, holds true for ERAJIA as well as adult SpA. Concurrently there is increasing interest in the role of imaging (MRI in particular) and HLA-B27 tissue typing in ERA-JIA diagnosis. This session will review current evidence of the pathophysiology, presentation, diagnosis and management of ERA-JIA. Clinical cases will be used to illustrate the challenges in, and practical approaches to, managing YP with SpA and to make observations about prognosis in adulthood. This session will also demonstrate that both increasing links between adult and paediatric rheumatology multidisciplinary teams, and understanding adolescence as a distinct developmental stage, are key components in providing effective clinical care for patients with adolescent-onset SpA.