Nutritional supplementation and dietary restriction in the resolution of enthesitis-related arthritis

Previously considered a chronic condition, enthesitis-related arthritis – a type of juvenile idiopathic arthritis – may in some cases represent a sensitivity-related illness and thus respond to antigenic avoidance and remediation of biochemistry. Enthesitis-related arthritis is a rare but serious cause of childhood disability and chronic pain that often leads to continuing complications in adult life. Forming a small (1–16%) subset of children with juvenile idiopathic arthritis, enthesitis-related arthritis patients typically experience enthesitis and asymmetrical hip and lower extremity arthritis. Common systemic features include acute iritis and subclinical inflammatory bowel disease (IBD), while symptomatic cardiac myopathies and pulmonary parenchymal disease occur less commonly. Unlike adult-onset spondyloarthropathies, sacroiliitis in enthesitis-related arthritis tends to present years after disease onset. To meet International League of Associations for Rheumatology (ILAR) classification for enthesitis-related arthritis, patients must have (1) arthritis and enthesitis; or (2) arthritis or enthesitis with at least two of the following: