Pediatric Juvenile Ankylosing Spondylitis

JAS strikes young people, typically between ages 17 and 35, but it also may affect adolescents. JAS is thought to affect males two to three times more often than it does females.

Symptoms of JAS tend to occur and disappear over periods of time. The following are the most common symptoms of JAS. However, each child may experience symptoms differently. Symptoms may include:

• Back pain, usually most severe at night during rest
• Early morning stiffness
• Stooped posture in response to back pain (bending forward tends to relieve the pain)
• Inability to take a deep breath, if the joints between the ribs and spine are affected
• Appetite loss
• Weight loss
• Fatigue
• Fever
• Anemia
• Pain at the site of attachment of muscles, ligaments, and/or tendons to bone (enthesitis)
• Joint pain, particularly in the legs
• Vague pain, usually in the buttocks, thighs, heels or near the shoulders
• Eye inflammation that is painful and causes redness and light sensitivity; may have frequent recurrences of eye inflammation
• Organ damage, such as the heart, lungs and eyes

Symptoms of juvenile ankylosing spondylitis may resemble other medical conditions or problems. Always consult your child's doctor for a diagnosis.

In addition to a complete medical history and physical examination, diagnostic procedures for juvenile ankylosing spondylitis may include:

• X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.
• Erythrocyte sedimentation rate (ESR or sed rate). A measurement of how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. Thus, when measured, they fall and settle faster at the bottom of the test tube. Generally, the faster the blood cells fall, the more severe the inflammation. (People with JAS often have an elevated ESR.)
• Detection of (HLA-B27) antigen. HLA-B27 is an antigen (a substance that causes the body to produce antibodies to fight bacteria, viruses and other "foreign" particles to prevent infection) whose presence may indicate the presence of some type of autoimmune disease (a condition in which the body's own defenses begin to attack the body's cells).

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.

Specific treatment for juvenile ankylosing spondylitis will be determined by your child's doctor based on:

• Your child's overall health and medical history
• Extent of the condition
• Your child's tolerance for specific medications, procedures and therapies
• Expectation for the course of the disease
• Your opinion or preference

Treatment may include:

• Nonsteroidal anti-inflammatory medication, NSAIDs, (to reduce pain and inflammation)
• Short-term use of corticosteroids (to reduce inflammation)
• Disease modifying antirheumatic drugs (DMARDS), such as methotrexate or biologics, such as infliximab or etanercept, which are designed to interfere with your body's inflammatory response 
• Maintain proper posture
• Regular exercise, including exercises that strengthen back muscles
• Physical therapy