Juvenile ankylosing spondylitis (JAS) is a chronic inflammatory disorder belonging to the group of juvenile-onset spondyloarthritides. It occurs prior to the age of 16 years and primarily leads to enthesopathy, spinal abnormalities, and peripheral joint inflammation.
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that causes pathologic changes both axially and in the regions of ligament and tendon attachments to the skeleton . Juvenile ankylosing spondylitis (JAS) affects children and adolescents younger than 16 years of age and presents considerably differently than adult-onset AS. One of the first mentions of JAS in the scientific literature was by Moll and Wright in 1976 which described a pediatric disease that mainly leads to an inflammation of the entheses and peripheral joints, possibly progressing to axial involvement  .
The initial manifestations with which JAS patients present are that of monoarthritis or oligoarthritis that usually involves peripheral enthesitis, tarsal disease, and, relatively rarely, sacroiliitis and spinal inflammation . The predominance of lower extremity involvement is irrefutable in JAS and arthritis tends to be asymmetric. Disease progression is also fluctuant. Some patients may experience one occurrence of asymmetric arthritis that responds to treatment and does not recur, whereas others may face a progressive disease that will eventually cause serious sequelae to the affected structures . Even though it is a rare clinical manifestation diagnosed in approximately 1/5 of JAS patients, acute anterior uveitis may coexist and so may additional extra-articular manifestations, including conduction heart disease, valvular disease, and lung disease   . Spinal involvement usually appears years after the early symptoms have been observed, mostly after an average period of 6 to 8 years . Nonspecific complaints which may also be reported by the young patients include a kyphotic appearance due to progressed disease that has affected the spine, weight loss, decreased appetite, fatigue, and dyspnea.
Entire Body System
Reactive arthritis was suspected due to conjunctivitis, arthritis and a previous episode of watery diarrhea. An ophthalmologic examination showed no evidence of uveitis. [ncbi.nlm.nih.gov]
knee M08.061 Unspecified juvenile rheumatoid arthritis, right knee M08.062 Unspecified juvenile rheumatoid arthritis, left knee M08.069 Unspecified juvenile rheumatoid arthritis, unspecified knee M08.07 Unspecified juvenile rheumatoid arthritis, ankle [icd10data.com]
Years ago, there were three types of juvenile rheumatoid arthritis that were recognized. In the United States, juvenile rheumatoid arthritis was also referred to as JRA, or juvenile arthritis. [verywell.com]
Juvenile Arthritis (JA) is a term used to categorize the different types of arthritis affecting children. The most common type of JA is Juvenile Rheumatoid Arthritis (JRA). [spineuniverse.com]
Low Back Pain
Juvenile ankylosing spondylitis affected youths in their early teens, who presented most commonly with appendicular joint complaints rather than low back pain. [ncbi.nlm.nih.gov]
Low back pain may travel down the back into the butt and thighs. The hips and back may feel stiff, tender, and painful. If the chest (thoracic spine) is affected, AS can make it difficult to take a deep breath. [spineuniverse.com]
They less commonly have low back pain and stiffness. Therefore, a young child with isolated complaint of the sacroiliac joint or lower back, an infection is more likely to be suspected than a JoAS. [myvmc.com]
Joint swelling 6wks: Jia/jra - general guide 1. [healthtap.com]
Joint swelling is common but is often first noticed in larger joints such as the knee. Stiffness. You might notice that your child appears clumsier than usual, particularly in the morning or after naps. Fever, swollen lymph nodes and rash. [mayoclinic.org]
JRA causes joint swelling, pain and stiffness that can last anywhere from a few months to a lifetime, depending on the individual. JRA is classified as an autoimmune disorder, a condition in which the body’s immune system attacks itself. [nynjcmd.com]
It causes joint swelling, pain, stiffness, and loss of motion. It can affect any joint, but is more common in the knees, hands, and feet. In some cases it can affect internal organs as well. [medlineplus.gov]
The joint problems involve large joints, such as the hips and sacroiliac joints. Swelling of entire toes or fingers, resulting in sausage digits, also occurs. [northshore.org]
(Level of evidence 4) 4.0 4.1 4.2 4.3 4.4 4.5 Giles LGF. et al., The clinical anatomy and management of back pain series, Volume 2 Clincal Anatomy and Management of Thoracic Spine Pain, Butterworth Heinemann, 2000: 61-66. [physio-pedia.com]
Lumbosacral Back Pain
ILAR Criteria Patients are said to have enthesitis-related arthritis if they have arthritis or enthesitis and two of the following Sacroiliac joint tenderness [either at time of presentation or in history] Inflammatory lumbosacral back pain Presence of [boneandspine.com]
Diagnosis of both juvenile and adult ankylosing spondylitis, similarly to other spondyloarthritides, is frequently delayed, with up to 10 years passing from the occurrence of the initial symptoms to the definitive diagnosis . JAS is often underdiagnosed or misdiagnosed, and the wider medical community displays a lack of adequate level of information regarding such rheumatic conditions.
The 1984 Modified New York Criteria for the diagnosis of AS are used to diagnose JAS as well and include:
- Lumbar spine motion restriction (sagittal and frontal planes)
- ≥ 3 months of low back pain that improves with exercise and aggravates by rest
- Restriction of chest expansion compared to the normative population
- ≥ grade 2 bilateral sacroiliitis
- grade 3 or 4 unilateral sacroiliitis
The diagnosis of JAS is made when at least one clinical manifestation and at least one radiologic parameter are present.
Sacroiliitis is usually diagnosed radiographically. The disadvantage of this imaging modality is that sacroiliac joint involvement will be depicted on an X-ray late in the course of the disease. Due to this reason, magnetic resonance imaging (MRI) scans has been gaining ground in the depiction of sacroiliitis in pediatric patients with suspected JAS. According to a study by Bollow et al., an MRI scan is considerably more sensitive to diagnose sacroiliac involvement in JAS patients than a plain radiograph .
Nine of the 10 patients exhibited the genetic marker HLA B27, but only one patient was homozygous for HLA B27. This prevalence of homozygosity among HLA B27 positive persons could be expected to occur by chance alone. [ncbi.nlm.nih.gov]
If your child has HLA-B27, she may have a genetic susceptibility (increased chance) of developing JAS. But it's important to remember that while most people with JAS do have HLA-B27, only a few people with HLA-B27 ever actually have JAS. [childrenshospital.org]
In both patients, treatment with infliximab at a dosage of 5 mg/kg body weight already led to considerable improvement with loss of joint pain the day after it was given. [ncbi.nlm.nih.gov]
Inactive phase of the disease during treatment with etanercept was recorded after 4 weeks, remission - at 7th month of treatment. [pharmateca.ru]
The goals of treatment for JAS are to: Reduce pain and stiffness Prevent deformities Help your child be as active as possible Treatment will depend on your child’s symptoms, age, and general health. [urmc.rochester.edu]
Treatment for juvenile idiopathic arthritis While there is no cure for juvenile idiopathic arthritis, treatment advances are allowing more children to live normal lives. [jointhealth.org]
[…] patients with worse prognosis to receive intensive therapy earlier in their disease course." [rheumatologynews.com]
Current therapies, including the use of biologic medications, have improved the prognosis of this condition significantly. [pedsinreview.aappublications.org]
[…] cell-mediated immune system are involved T-cells release tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-1 the humoral immune system is involved by increasing antinuclear antibody (ANA) production, immunoglobulins, and circulating immune complexes Prognosis [medbullets.com]
The etiology is not completely understood but is known to be multifactorial, with both genetic and environmental factors playing key roles. [pedsinreview.aappublications.org]
It is a chronic inflammatory rheumatic disease with unknown etiology. AS is associated with the HLA-B27 antigen and also with other chronic inflammatory diseases. [physio-pedia.com]
A bacterial etiology, in the absence of immune dysfunction, is unlikely in polyarticular disease. Chronic recurrent multifocal osteomyelitis, a sterile bone inflammation of unknown etiology, is also to be considered. [rheumatologyadvisor.com]
There was evidence of an alternate trigger aside from the vaccine, and epidemiologic evidence that JAS is not associated with Gardasil. Further, it was not shown that Gardasil can trigger JAS. [mctlawyers.com]
[…] pain and inflammation 1 or more joints are involved for at least 6 weeks in patients 16 years of age subtypes polyarticular juvenile idiopathic arthritis (JIA) 5 joints involved pauciarticular JIA 1-4 joints involved systemic JIA visceral involvement Epidemiology [medbullets.com]
[…] synovial process disc space involvement inflammation of the annulus lead to bridging osteophyte formation (syndesmophytes) Genetics there is a genetic predisposition, but mode of inheritance is unknown HLA-B27 is located on sixth chromosome, B locus Epidemiology [orthobullets.com]
She completed a master’s degree in epidemiology at the University of Washington School of Public Health and Community Medicine, Seattle, and a fellowship in pediatric rheumatology at Children’s Hospital and Regional Medical Center, University of Washington [aafp.org]
Objectives After completing this article, readers should be able to: Understand the pathophysiology of juvenile idiopathic arthritis (JIA). Recognize the clinical features of the different types of JIA. Be aware of the complications of JIA. [pedsinreview.aappublications.org]
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Certain cytokines appear to have a prominent role in the pathophysiology of SpA. [ped-rheum.biomedcentral.com]
Pathophysiology of Ankylosing Spondylitis Ankylosing spondylitis and other spondyloarthropathies are chronic inflammatory diseases affecting the sacroiliac joints, axial skeleton, and, peripheral joints. [boneandspine.com]
Thorough clinical, radiographic, and laboratory examination should prevent confusion with juvenile rheumatoid arthritis. [ncbi.nlm.nih.gov]
PHARMACOECONOMIC ANALYSIS OF GENETICALLY ENGINEERED BIOLOGICAL PRODUCTS USED IN THE TREATMENT OF PSORIATIC ARTHRITIS AND ANKYLOSING SPONDYLITIS PROSPECTS FOR ANTI-B-CELL THERAPY OF SYSTEMIC LUPUS ERYTHEMATOSUS MODERN APPROACHES TO TREATMENT OF JUVENILE ARTHRITIS Prevention [pharmateca.ru]
Treatment for juvenile ankylosing spondylitis The goal of treatment for JAS is to reduce pain and stiffness, prevent deformities, and help your child maintain as normal and active a lifestyle as possible. [stanfordchildrens.org]
Even though the patient may have pain and stiffness, it seldom prevents the person from leading a normal and productive life. Updated on: 02/28/18 Juvenile Idiopathic Arthritis Treatment [spineuniverse.com]
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