{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T18:53:53Z","timestamp":1769626433670,"version":"3.49.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T00:00:00Z","timestamp":1609891200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T00:00:00Z","timestamp":1609891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Rheumatol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Observations among Israeli pediatric rheumatologists reveal that pediatric Juvenile Spondyloarthritis (JSpA) may present differently compared to patients from the United States (US). This study is aimed to compare the demographic and clinical variables of Israeli and US JSpA patients upon presentation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We performed a retrospective, cross-sectional, multicenter comparison of JSpA patients among 3 large Israeli pediatric rheumatology centers and a large US pediatric rheumatology center. Patients with diagnosis of Juvenile Ankylosing Spondylitis (JAS) and\/or Enthesitis-related Arthritis (ERA) were included. The demographic, clinical and radiologic features were compared.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Overall 87 patients were included (39 Israeli, 48 US patients). Upon presentation, inflammatory back pain, sacroiliac joint tenderness and abnormal modified Schober test, were significantly more prevalent among Israeli patients (59% vs. 35.4, 48.7% vs. 16.7, and 41.2% vs. 21.5%, respectively, all <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), whereas peripheral arthritis and enthesitis were significantly more prevalent among US patients (43.6% vs. 91.7 and 7.7% vs. 39.6% in Israeli patients vs. US patients, p\u2009&lt;\u20090.05). In addition, 96.7% of the Israeli patients versus 29.7% of the US patients demonstrated sacroiliitis on MRI (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, <jats:italic>N<\/jats:italic>\u2009=\u200967). Less than one-third of the Israeli patients (32%) were HLA-B27 positive vs. 66.7% of US patients (<jats:italic>p<\/jats:italic>\u2009=\u20090.007).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Israeli children with JSpA presented almost exclusively with axial disease compared to US patients who were more likely to present with peripheral symptoms. HLA B27 prevalence was significantly lower in the Israeli cohort compared to the US cohort. Further studies are needed to unravel the genetic and possibly environmental factors associated with these findings.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12969-020-00489-8","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T22:03:49Z","timestamp":1609970629000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Do geography and ethnicity play a role in juvenile Spondyloarthritis? A multi-center binational retrospective study"],"prefix":"10.1186","volume":"19","author":[{"given":"Nassem","family":"Ghantous","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merav","family":"Heshin-Bekenstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Dequattro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaniv","family":"Lakovsky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir Moshe","family":"Hendel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadav","family":"Rappoport","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yonatan Butbul","family":"Aviel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irit","family":"Tirosh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liora","family":"Harel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela F.","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lianne","family":"Gensler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Mackenzie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3888-429X","authenticated-orcid":false,"given":"Gil","family":"Amarilyo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,1,6]]},"reference":[{"key":"489_CR1","first-page":"238","volume-title":"Textbook of pediatric rheumatology","author":"SML Tse","year":"2015","unstructured":"Tse SML, Petty RE. Enthesitis related arthritis. In: Petty RE, Laxer RM, Lindsley C, Wedderburn L, editors. Textbook of pediatric rheumatology. Philadelphia: Saunders; 2015. p. 238\u201355."},{"key":"489_CR2","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1038\/nrrheum.2012.37","volume":"8","author":"SML Tse","year":"2012","unstructured":"Tse SML, Laxer RM. New advances in juvenile spondyloarthritis. Nat Rev Rheumatol. 2012;8:269\u201379.","journal-title":"Nat Rev Rheumatol"},{"key":"489_CR3","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1053\/berh.2002.0247","volume":"16","author":"R Burgos-Vargas","year":"2002","unstructured":"Burgos-Vargas R, Pacheco-Tena C, V\u00e1zquez-Mellado J. The juvenile-onset spondyloarthritides: rationale for clinical evaluation. Best Pract Res Clin Rheumatol. 2002;16:551\u201372.","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"489_CR4","first-page":"1542","volume":"18","author":"H Mielants","year":"1991","unstructured":"Mielants H, Veys EM, Goemaere S, Goethals K, Cuvelier C, De Vos M. Gut inflammation in the spondyloarthropathies: clinical, radiologic, biologic and genetic features in relation to the type of histology. A prospective study. J Rheumatol. 1991;18:1542\u201351.","journal-title":"J Rheumatol"},{"key":"489_CR5","first-page":"1567","volume":"20","author":"H Mielants","year":"1993","unstructured":"Mielants H, Veys EM, Cuvelier C, De Vos M, Goemaere S, Maertens M, et al. Gut inflammation in children with late onset pauciarticular juvenile chronic arthritis and evolution to adult spondyloarthropathy: a prospective study. J Rheumatol. 1993;20:1567\u201372.","journal-title":"J Rheumatol"},{"key":"489_CR6","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1177\/1759720X12458372","volume":"4","author":"IE Van Der Horst-Bruinsma","year":"2012","unstructured":"Van Der Horst-Bruinsma IE, Nurmohamed MT. Management and evaluation of extra-articular manifestations in spondyloarthritis. Ther Adv Musculoskelet Dis. 2012;4:413\u201322.","journal-title":"Ther Adv Musculoskelet Dis"},{"key":"489_CR7","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1097\/BOR.0000000000000185","volume":"27","author":"S Gmuca","year":"2015","unstructured":"Gmuca S, Weiss PF. Juvenile spondyloarthritis. Curr Opin Rheumatol. 2015;27:364\u201372.","journal-title":"Curr Opin Rheumatol"},{"key":"489_CR8","first-page":"1991","volume":"25","author":"RE Petty","year":"1998","unstructured":"Petty RE, Southwood TR, Baum J, Bhettay E, Glass DN, Manners P, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol. 1998;25:1991\u20134.","journal-title":"J Rheumatol"},{"key":"489_CR9","first-page":"390","volume":"31","author":"RE Petty","year":"2004","unstructured":"Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390\u20132.","journal-title":"J Rheumatol"},{"issue":"1","key":"489_CR10","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1007\/s11926-020-0880-3","volume":"22","author":"DG Rumsey","year":"2020","unstructured":"Rumsey DG, Laxer RM. The challenges and opportunities of classifying childhood arthritis. Curr Rheumatol Rep. 2020 Jan 11;22(1):4.","journal-title":"Curr Rheumatol Rep"},{"key":"489_CR11","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1038\/nrrheum.2012.41","volume":"8","author":"JD Reveille","year":"2012","unstructured":"Reveille JD. Genetics of spondyloarthritis- beyond the MHC. Nat Rev Rheumatol. 2012;8:296\u2013304.","journal-title":"Nat Rev Rheumatol"},{"key":"489_CR12","doi-asserted-by":"publisher","first-page":"2395","DOI":"10.3899\/jrheum.100090","volume":"37","author":"I Pagnini","year":"2010","unstructured":"Pagnini I, Savelli S, Matucci-Cerinic M, Fonda C, Cimaz R, Simonini G. Early predictors of juvenile sacroiliitis in enthesitis-related arthritis. J Rheumatol. 2010;37:2395\u2013401.","journal-title":"J Rheumatol"},{"key":"489_CR13","doi-asserted-by":"publisher","first-page":"2402","DOI":"10.3899\/jrheum.100014","volume":"37","author":"ML Stoll","year":"2010","unstructured":"Stoll ML, Bhore R, Dempsey-Robertson M, Punaro M. Spondyloarthritis in a pediatric population: risk factors for sacroiliitis. J Rheumatol. 2010;37:2402\u20138.","journal-title":"J Rheumatol"},{"issue":"11","key":"489_CR14","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/S1726-4901(09)70432-0","volume":"72","author":"YC Lin","year":"2009","unstructured":"Lin YC, Liang TH, Chen WS, Lin HY. Differences between juvenile-onset Ankylosing spondylitis and adult-onset Ankylosing spondylitis. Journal of the Chinese Medical Association. 2009;72(11):573\u201380.","journal-title":"Journal of the Chinese Medical Association"},{"issue":"3","key":"489_CR15","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/S0889-857X(05)70348-3","volume":"23","author":"R Burgos-Vargas","year":"1997","unstructured":"Burgos-Vargas R, Pacheco-Tena C, V\u00e1zquez-Mellado J. Juvenile-onset spondyloarthropathies. Rheum Dis Clin N Am. 1997 Aug;23(3):569\u201398.","journal-title":"Rheum Dis Clin N Am"},{"key":"489_CR16","unstructured":"Dixon WJ, (chief editor). BMDP Statistical Software Manual, Volume 1 and 2. Los Angeles: University of California Press, Berkeley; 1993."},{"key":"489_CR17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12969-018-0238-9","volume":"16","author":"M Goirand","year":"2018","unstructured":"Goirand M, Breton S, Chevallier F, Duong NP, Uettwiller F, Melki I, et al. Clinical features of children with enthesitis-related juvenile idiopathic arthritis \/ juvenile spondyloarthritis followed in a French tertiary care pediatric rheumatology Centre. Pediatr Rheumatol Online J. 2018;16:1\u20139.","journal-title":"Pediatr Rheumatol Online J"},{"key":"489_CR18","doi-asserted-by":"publisher","first-page":"2167","DOI":"10.1093\/rheumatology\/key246","volume":"57","author":"A Zanwar","year":"2018","unstructured":"Zanwar A, Phatak S, Aggarwal A. Prospective validation of the juvenile Spondyloarthritis disease activity index in children with enthesitis-related arthritis. Rheumatology. 2018;57:2167\u201371.","journal-title":"Rheumatology"},{"key":"489_CR19","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/s13075-017-1297-x","volume":"19","author":"S Gmuca","year":"2017","unstructured":"Gmuca S, Xiao R, Brandon TG, Pagnini I, Wright TB, Beukelman T, et al. Multicenter inception cohort of enthesitis-related arthritis: variation in disease characteristics and treatment approaches. Arthritis Res Ther. 2017;19:84.","journal-title":"Arthritis Res Ther"},{"key":"489_CR20","doi-asserted-by":"publisher","first-page":"896","DOI":"10.3899\/jrheum.180412","volume":"46","author":"M Kishimoto","year":"2019","unstructured":"Kishimoto M, Yoshida K, Ichikawa N, Inoue H, Kaneko Y, Kawasaki T, et al. Clinical characteristics of patients with Spondyloarthritis in Japan in comparison with other regions of the world. J Rheumatol. 2019;46:896\u2013903.","journal-title":"J Rheumatol"},{"issue":"6","key":"489_CR21","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1002\/art.1780380618","volume":"38","author":"V-MJ Burgos-Vargas","year":"1995","unstructured":"Burgos-Vargas V-MJ. The early clinical recognition of juvenile-onset ankylosing spondylitis and its differentiation from juvenile rheumatoid arthritis. Arthritis Rheum. 1995;38(6):835\u201344.","journal-title":"Arthritis Rheum"},{"key":"489_CR22","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s40744-018-0100-z","volume":"5","author":"G Bodis","year":"2018","unstructured":"Bodis G, Toth V, Schwarting A. Role of human leukocyte antigens (HLA) in autoimmune diseases. Rheumatol Ther. 2018;5:5\u201320.","journal-title":"Rheumatol Ther"},{"key":"489_CR23","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1186\/ar4228","volume":"15","author":"ME Costello","year":"2013","unstructured":"Costello ME, Elewaut D, Kenna TJ, Brown MA. Microbes, the gut and ankylosing spondylitis. Arthritis Res Ther. 2013;15:214.","journal-title":"Arthritis Res Ther"},{"key":"489_CR24","doi-asserted-by":"publisher","first-page":"1974","DOI":"10.1002\/art.22709","volume":"56","author":"RK Saurenmann","year":"2007","unstructured":"Saurenmann RK, Rose JB, Tyrrell P, Feldman BM, Laxer RM, Schneider R, et al. Epidemiology of juvenile idiopathic arthritis in a multiethnic cohort: Ethnicity as a risk factor. Arthritis Rheum. 2007;56:1974\u201384.","journal-title":"Arthritis Rheum"},{"key":"489_CR25","doi-asserted-by":"publisher","first-page":"472","DOI":"10.3109\/03009741003742722","volume":"39","author":"C Modesto","year":"2010","unstructured":"Modesto C, Ant\u00f3n J, Rodriguez B, Bou R, Arnal C, Ros J, et al. Incidence and prevalence of juvenile idiopathic arthritis in Catalonia (Spain). Scand J Rheumatol. 2010;39:472\u20139.","journal-title":"Scand J Rheumatol"},{"key":"489_CR26","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jbspin.2009.11.002","volume":"77","author":"E Solau-Gervais","year":"2010","unstructured":"Solau-Gervais E, Robin C, Gambert C, Troller S, Danner S, Gombert B, et al. Prevalence and distribution of juvenile idiopathic arthritis in a region of Western France. Joint Bone Spine. 2010;77:47\u20139.","journal-title":"Joint Bone Spine"},{"key":"489_CR27","doi-asserted-by":"publisher","first-page":"2341","DOI":"10.3899\/jrheum.120642","volume":"39","author":"PF Weiss","year":"2012","unstructured":"Weiss PF, Beukelman T, Schanberg LE, Kimura Y, Colbert RA. Enthesitis-related arthritis is associated with higher pain intensity and poorer health status in comparison with other categories of juvenile idiopathic arthritis: the childhood arthritis and rheumatology research Alliance registry. J Rheumatol. 2012;39:2341\u201351.","journal-title":"J Rheumatol"},{"issue":"4","key":"489_CR28","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1002\/acr.20044","volume":"62","author":"K Oen","year":"2010","unstructured":"Oen K, Duffy C, Tse SML, Ramsey S, Ellsworth J, Ch\u00e9deville G, et al. Early outcomes and improvement of patients with juvenile idiopathic arthritis enrolled in a Canadian multicenter inception cohort. Arthritis Care Res (Hoboken). 2010;62(4):527\u201336.","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"489_CR29","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/s00296-003-0325-0","volume":"24","author":"O Elkayam","year":"2004","unstructured":"Elkayam O, Segal R, Caspi D. Human leukocyte antigen distribution in Israeli patients with psoriatic arthritis. Rheumatol Int. 2004;24:93\u20137.","journal-title":"Rheumatol Int"},{"issue":"5","key":"489_CR30","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.1002\/art.33503","volume":"64","author":"JD Reveille","year":"2012","unstructured":"Reveille JD, Hirsch R, Dillon CF, Carroll MD, Weisman MH. The prevalence of HLA-B27 in the US: data from the US National Health and nutrition examination survey, 2009. Arthritis Rheum. 2012 May;64(5):1407\u201311.","journal-title":"Arthritis Rheum"},{"key":"489_CR31","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1002\/acr.22665","volume":"68","author":"PF Weiss","year":"2016","unstructured":"Weiss PF, Xiao R, Biko DM, Chauvin NA. Assessment of Sacroiliitis at diagnosis of juvenile Spondyloarthritis by radiography, magnetic resonance imaging, and clinical examination. Arthritis Care Res (Hoboken). 2016;68:187\u201394.","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"489_CR32","first-page":"556","volume":"25","author":"M Bollow","year":"1998","unstructured":"Bollow M, Biedermann T, Kannenberg J, Paris S, Schauer-Petrowski C, Minden K, et al. Use of dynamic magnetic resonance imaging to detect sacroiliitis in HLA-B27 positive and negative children with juvenile arthritides. J Rheumatol. 1998;25:556\u201364.","journal-title":"J Rheumatol"}],"container-title":["Pediatric Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12969-020-00489-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12969-020-00489-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12969-020-00489-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T22:36:37Z","timestamp":1609972597000},"score":1,"resource":{"primary":{"URL":"https:\/\/ped-rheum.biomedcentral.com\/articles\/10.1186\/s12969-020-00489-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,6]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["489"],"URL":"https:\/\/doi.org\/10.1186\/s12969-020-00489-8","relation":{},"ISSN":["1546-0096"],"issn-type":[{"value":"1546-0096","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,6]]},"assertion":[{"value":"12 May 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 December 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 January 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"An IRB was obtained from Rabin Helsinki commitee (the main center\u2019s ethics review board No. 0186\u201317-RMC) and from all participating sites (Rambam Medical Center Helsinki commititee, Sheba Medical Center Helsinki commititee and University of California San Francisco Institioinal board review).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"There are no conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"4"}}