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Enthesitis-related arthritis (ERA)

What is juvenile iIdiopathic arthritis (JIA)?

Juvenile idiopathic arthritis (JIA) is a condition where inflammation of one or more joints happens in children under the age of 16 years old which lasts for at least 6 weeks. Inflammation can cause pain, swelling, stiffness or loss of motion in the affected joints. The stiffness can be worse first thing in the morning or after resting.

What is enthesitis-related arthritis (ERA)?

Enthesitis-related arthritis (ERA) is a type of JIA which also causes enthesitis. Enthesitis is swelling or inflammation of an ‘enthesis’ which is a part of the joint which attaches to the bone).

Illustration of diagram of knee showing enthesis which is part of the joint which attaches to the bone

Between 10 to 20 per cent of all children with arthritis have ERA. It affects boys much more often than girls and usually starts in late childhood or teenage years.

ERA usually happens with widespread muscle tightness which can make symptoms more severe and normal activities more difficult to do. The most commonly affected joints at diagnosis are the lower back, knees, ankles, hips and the small joints of the toes and feet.

ERA does not affect everybody in the same way. For some children it can be mild and only last for a short time. For others it can be more severe and last for a long time. ERA may have flare-ups, when the condition gets worse, and remissions, when symptoms can get better or disappear.

What causes enthesitis-related arthritis (ERA)?

Inflammation or swelling is a normal process in the body. It is one of the ways that our body’s immune system protects us from disease and infection.

This means ERA is an autoimmune disorder. It is when the immune system attacks healthy cells in the body by mistake, causing inflammation. However it is not known what exactly happens to cause this.

How is enthesitis-related arthritis (ERA) diagnosed?

The doctor will take a medical history and carry out a physical examination to see if there are any signs of joint inflammation. Your child may also need to have blood tests, X-rays and sometimes other tests such as magnetic resonance imaging (MRI) to help with the diagnosis.

A blood test can be helpful when trying to diagnose ERA. It can tell us who is at higher risk of developing ERA, but it does not always prove if your child has ERA.


Uveitis an inflammation that can cause someone to lose their vision. It happens in part of the eye, which is often associated with other inflammatory conditions such as ERA.

Symptoms include a red eye, pain and sensitivity to light. It is important to note that not everyone will experience symptoms until the disease has progressed. Routine eye examinations are important in screening for any signs of inflammation. The rheumatology team will discuss monitoring for this with you.

What is the treatment for enthesitis-related arthritis (ERA)?

There are different medicines available to treat ERA which can help to reduce inflammation and help your child with pain. Other medicines suppress the immune system in order to help control inflammation and prevent joint damage. The rheumatology team will offer you further information about the individual treatment plan for your child.

Physiotherapy and occupational therapy (OT) have an important role in helping arthritis and ERA in particular, and your child will be offered an assessment and follow-up treatment if needed. They can help your child to maintain independence through improving their flexibility, mobility and strength.

Contact us

If you have any questions or concerns, please contact the Rheumatology Team on 0114 271 7786 or email us on rheumatology.nurses@nhs.net

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Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

Resource number: RHM16

Resource Type: Article

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Rheumatology Team

Tel: 0114 2717786

e-mail: rheumatology.nurses@nhs.net


Western Bank
S10 2TH

United Kingdom

Switchboard: 0114 271 7000

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