Pharmacotherapy for juvenile spondyloarthritis: an overview of the available therapies

ABSTRACT

Introduction

Spondyloarthropathies (SpA) represent a heterogeneous group of inflammatory arthritides with autoimmune pathogenesis that can affect both adults and children with peculiar features such as enthesitis, sacroiliac joint, and axial involvement. Since juvenile onset of SpA (JSpA) is not well codified by the current juvenile idiopathic arthritis classification, studies in this field are restricted to single categories and therefore cannot be exhaustive. This review aims to report recent advances in the treatment of JSpA.

Areas covered

In order to assess the available therapies for JSpA, the authors have analyzed data obtained from retrospective and prospective studies, case reports, and case series, as well as from controlled trials.

Expert opinion

Given the challenging classification of JSpA, research in this field has been restricted to single subcategories. Little is known of which patients are more likely to develop axial involvement leading to severe spinal damage. Whether TNF inhibitors are capable to prevent or stop disease progression, once started, is yet to be ascertained with structural damage still a matter for research. Therefore, trials on the efficacy of TNF inhibitors in JSpA are strongly advocated since they may help to elucidate their place as a treatment option.

KEYWORDS:

• Anti TNF-α
• TNF inhibitors
• DMARDs
• enthesitis-related arthritis
• juvenile idiopathic arthritis
• psoriatic arthritis
• spondyloarthropathy

Article highlights

• Given the evolving JIA classification, studies on JSpA are restricted to single subcategories and therefore cannot be exhaustive.

• Treatment of JSpA is determined by several factors including the presence of peripheral arthritis, enthesitis, and axial involvement.

• Tumor necrosis factor (TNF) inhibitors have been shown to be effective in JSpA

• Whether TNF inhibitors are capable to prevent or to stop, once started, structural damage is still focus of research.

• The choice of a particular TNF inhibitor is guided by the presence of concomitant involvement of certain organ systems. Indeed, in case of recurrent iritis or inflammatory bowel disease, anti-TNF-α monoclonal antibodies (adalimumab or infliximab) should be preferred over etanercept.

• The blockage of the interleukin-17 and −12/23 pathways and JAK inhibition might be valid options for the treatment of JSpA; nevertheless, further studies in children are advisable.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.