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Enthesitis-Related Arthritis (ERA): A Guide for Teenagers

You have been told you have arthritis. You may wonder what it is and what it means for you. You may be scared or worried about how this will change what you like to do, what your friends might think, or your future plans for school or a career. Here is a quick guide to look at to help you learn about your type of arthritis and what it means for you.

What is enthesitis-related arthritis?

Enthesitis-related arthritis (ERA for short) is a type of childhood arthritis.

Arthritis means “joint swelling” or “joint inflammation”. Arthritis leads to pain, swelling, stiffness, and loss of motion in the joints. In ERA, the arthritis is mainly in the lower limbs (the hip, knee, and foot). Arthritis in the back (spondylitis) and sacroiliac joint (sacroiliitis) is not as common at first, but can occur later. Arthritis in the sacroiliac joint can give you pain in the low back or bum area. The pain becomes worse with rest and better with activity. Arthritis can also occur in the upper limbs. The shoulders are more commonly affected.

Joints Affected by Enthesitis Arthritis (ERA)
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Arthritis in the lower joints can be part of ERA. Some children have just the arthritis, some have just the enthesitis, some have a combination of both.
 

Enthesitis means swelling or inflammation of the entheses, where tendons or ligaments attach to bone. Enthesitis can also lead to pain, swelling, and loss of motion around joints. If you have enthesitis, you may feel foot, heel, or knee pain, with or without swelling.

Entheses Affected by Enthesitis Arthritis (ERA)
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Entheses are where tendons and ligaments insert into bone. Enthesitis is inflammation of entheses.
 

ERA tends to occur in late childhood or adolescence (8 to 15 years of age). It is seen more often in boys than girls.

ERA can be different from person to person. For some, it can be mild and run a short course. For others, it can be more severe and last a long time. Some people with ERA may be at risk for developing back inflammation in their adult years.

ERA is an autoimmune disease

Your immune system normally fights infections, like a cold or flu. With ERA, your immune system is not working as it should. It has started attacking the cells and tissues in your body. It attacks your joints, causing arthritis and enthesitis.

ERA is treated with medicine

You may need to take different kinds of medicine for ERA. Medication is used for the following reasons:

  • to reduce inflammation of the joints and entheses
  • to take away pain and decrease swelling
  • to maintain function and movement of joints
  • to prevent damage to bone, cartilage, ligaments, and tendons within the joints

You may need to take these medicines for a short time, on and off for a number of years, or for many years. The amount of time you need to take the medicine depends on:

  • how you are feeling
  • if the doctor can see inflammation in your joints and entheses, by noticing swelling and warmth
  • if the doctor can see inflammation in your blood test

To learn more about treatment and medicines, please read Juvenile Enthesitis-Related Arthritis: Treatment.

When taking medicines, ask yourself these questions:

  • Do I know which pills I am taking?

  • Do I know how much or the dose I am taking?

  • Do I know why I am taking each of the pills?

  • Do I know what will happen if I do not take the pills?

If you cannot answer these questions, please speak to your doctor. Make sure you understand your medicines and why you need to take them.

Taking pills can be irritating. Some medicines can have unwanted effects on your body, called side effects. The side effects of some medicines may be unpleasant. Your doctor prescribes the smallest amount possible to make you feel better. Stopping medicines without telling your doctor will hurt your body and can be dangerous.

The side effects will not last. Once you finish taking the medicine, the side effects will disappear.

Talk to your doctor, nurse, pharmacist, or social worker about ways to make taking medicine easier and less painful.

Smoking and drinking alcohol

While you are taking medicine for ERA, you should not take any kind of drug, including alcohol and tobacco. Drugs interfere with the medicines you are taking. The combination could damage your liver or kidneys.

Sex and birth control

If you choose to be sexually active, then you need to know the following:

  • Certain medicines for arthritis can be very harmful to unborn babies. Measures must be taken to prevent pregnancies. For both boys and girls, please talk to your doctor about birth control.

  • Tell your doctor if you are sexually active or if you are thinking about it. Your doctor can help you choose the right method of birth control.

ERA and exercise

If you have been told you have ERA, it is important to exercise and remain active. Symptoms of pain, stiffness, and fatigue get worse during long periods of rest or inactivity. Symptoms improve dramatically with activity. Regular exercise for 20 to 30 minutes a day can do great things for you:

  • decrease pain and stiffness

  • keep muscles strong and flexible

  • develop strong muscles to support joints

  • improve energy

Good posture and back mobility exercises are important. A physiotherapist can help you with this. They can also make suggestions about activities and sports that may help. It is important to choose activities that you enjoy and can do regularly.

To learn more about exercises and stretches for ERA, please read Exercises for Enthesitis and Arthritis.

ERA and lifestyle for teens

It is important to remember that your life does not have to change too much if you have ERA. You may have to take pills to help get rid of inflammation, but you can still do the same things you did before. You can still go to school, do chores, play sports, and hang out with friends and family.

During a flare-up, ERA may make some activities harder because of the pain and stiffness in your joints. For example, teens whose knees, ankles, and feet are affected find that walking long distances and playing certain sports is a challenge. Try to take part in all your normal activities, but stop if it hurts.

These are some suggestions from teens who have experienced ERA:

  • Morning stiffness is common. Try waking up a bit earlier to take a hot shower for 10 to 15 minutes.

  • Use heating pads and hot water bottles on areas that are painful and stiff.

  • Stretch in the morning and during the day to keep joints moving well.

ERA should not affect your life goals. Remember, the treatment for ERA helps you have a normal life and do things you want to do.

Key points

  • Enthesitis-related arthritis (ERA) is an autoimmune disease that causes pain and swelling in the joints and the points where tendons and ligaments attach to bone (entheses).

  • ERA is treated with medicine. Depending on your situation, you may need to take medicine for a short time or for a longer time.

  • Exercise is important to help you manage your symptoms and stay healthy.

  • ERA may make some activities harder, but you can still do the same things you did before you were diagnosed with ERA.

Shirley Tse, MD, FRCPC

Michelle Anderson, BScN

Kristi Whitney, MSc, BScPT

5/21/2010




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