Nonpharmacological management for enthesitis-related arthritis

Nonpharmacological interventions have an important role in the management of enthesitis-related arthritis and are best delivered by a multidisciplinary team. The individual components may include:

• participation in physical activity
• use of psychological techniques
• finding opportunities for social connection.

Physical therapy is important to maintain flexibility and pelvic girdle strength, and orthoses are used to support the foot if there is any subtalar involvement, or to cushion painful entheses.

Children and adolescents with polyarticular juvenile idiopathic arthritis (JIA) may require targeted stretching and strengthening exercises, delivered by a physiotherapist or occupational therapist, in order to:

• maintain full range of motion of all joints
• optimise muscle strength (especially in the context of muscle atrophy)
• manage limb length discrepancies and joint contractures
• address gait abnormalities
• maintain full function.

Children with enthesitis-related arthritis are encouraged to remain active, including participating in sport. If physical activity causes discomfort, reassessment is recommended because symptoms may be due to an arthritis flare or there may be an alternative explanation for the pain (eg a benign mechanical condition).

Also consider age-appropriate, nonpharmacological acute pain management strategies.