Pediatric Juvenile Ankylosing Spondylitis

Juvenile ankylosing spondylitis is a type of arthritis. It affects the spine and the places where the muscles, tendons, and ligaments attach to the bone. Ankylosing means stiff or rigid. Spondyl means spine. It refers to inflammation.

JAS tends to start in the teens and 20s. It affects boys and men more than girls and women. JAS is a long-term (chronic) condition. Some people will have periods of time where the disease is not active or mild (remission). Others will have ongoing symptoms.

Researchers don't know the exact cause of JAS. It tends to run in families. A gene marker called HLA-B27 is found in almost all Caucasians and half of African Americans who have the disease. But only a very small number of people with the marker will develop the disease. Because of this, researchers don’t fully know if the gene marker increases the risk for the disease.

A child may be more at risk for JAS if they have:

• Family members with JAS.
• The gene marker HLA-B27.

Symptoms can happen a bit differently in each child. They tend to come and go over time. They can include:

• Pain in the back, joints, buttocks, thighs, heels or shoulders.
• Early morning stiffness that gets better with activity.
• Trouble standing up straight.
• Trouble taking a deep breath.
• Loss of appetite.
• Weight loss.
• Tiredness (fatigue).
• Fever.
• Eye pain, redness, and sensitivity to light.

The symptoms of JAS can look like other health conditions. Make sure your child sees their health care provider for a diagnosis.

Because the symptoms are similar to those in other conditions, JAS can be hard to diagnose.

The health care provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history. They will give your child a physical exam. Your child may also have tests, such as:

• X-rays. This test uses a small amount of radiation to make images of tissues in the body. X-rays may show changes in the spine and joints. Changes may not show up in the early stages.
• Other imaging tests. Other tests that make more detailed images of the body may be done. This may include MRI. This test uses large magnets and a computer to create images of tissues in the body.
• Blood tests. There are no specific tests for JAS. But general blood tests may be done, such as:
  
  • Erythrocyte sedimentation rate (ESR or sed rate). This test is done to see if there is inflammation in the body. A child with JAS may have a high ESR level, but this can also be due to other causes.
  • Detection of (HLA-B27) antigen. This is a blood test for certain autoimmune conditions. HLA-B27 is an antigen. If this antigen is present, it may mean there is some type of autoimmune disease. Like the ESR, the test result isn’t specific to JAS and may have another cause.

The diagnosis of JAS can be difficult. Your child's health care provider may advise that they be seen by a health care provider who specializes in joint diseases (rheumatologist).

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. It will also depend on how bad the condition is. Treatment may include:

• Nonsteroidal anti-inflammatory drugs, such as ibuprofen, to reduce pain and inflammation.
• Short-term use of corticosteroids to reduce inflammation.
• Disease-modifying antirheumatic medicines to slow down inflammation in the body.
• Biologic medicines, such as anti-TNF medicines, to slow down inflammation in the body.
• Regular exercise, including exercises that strengthen back muscles.
• Physical therapy.

Possible complications of JAS include:

• Joint damage.
• Bones of the spine and chest that grow together (fuse).
• Abnormal forward curve of the spine (kyphosis).
• Trouble breathing because of changes in the spine and chest (restrictive lung disease).
• Breaks in the bones of the spine.
• Heart, eye and kidney problems.

JAS is a long-term (chronic) condition. Some people will have periods of time in which the disease is not active or mild (remission) while others will have ongoing symptoms.

• Early diagnosis and treatment are important to reduce or delay complications. Help your child:
• Stay as active as possible.
• Balance activity with rest.
• Eat a healthy diet.

Also make sure your child stops smoking or never starts. Smoking has been linked to having more problems with JAS.

Work with your child's health care team to create an ongoing treatment plan that’s best for your child.