Gensler L S, Ward M M, Reveille J D, Learch T J, Weisman M H, Davis J C
University of California San Francisco, 533 Parnassus Avenue Box 0633 Room U383, San Francisco, CA 94143-0633, USA.
Ann Rheum Dis. 2008 Feb;67(2):233-7. doi: 10.1136/ard.2007.072512. Epub 2007 Jun 29.
Previous data suggests that patients with juvenile-onset ankylosing spondylitis (JoAS) have more severe disease and worse functional outcomes than adult-onset AS (AoAS). The purpose of this study was to evaluate clinical, functional and radiographic differences between patients with JoAS and AoAS in a large cohort of patients with long-standing disease.
A total of 402 subjects who met the Modified New York Criteria for definitive AS and had had disease >or=20 years were enrolled in a multi-centre cross-sectional study (Prospective Study of Outcomes in Ankylosing Spondylitis; PSOAS). JoAS was defined as initial symptoms <or=16 years of age. A total of 79 subjects with JoAS and 323 subjects with AoAS were identified. An analysis of clinical and demographic comparisons between the two groups was performed including HLA B27 status. Functional outcomes were assessed by Bath AS Functional Index (BASFI) and the Health Assessment Questionnaire modified for the Spondyloarthropathies (HAQS). Radiographic disease severity was assessed by the Bath AS Radiology Index (BASRI).
With the exception of obvious differences in age at onset and disease duration, demographic and clinical characteristics were similar between the two groups. However, the JoAS group trended towards more women (32.9 vs 22.9%, p = 0.07). Controlling for multiple covariates including disease duration, both the BASRI hip score and the need for total hip arthroplasty (THA) was higher in the JoAS group. The BASRI spine score (including total, lumbar and cervical spine) was significantly lower in the patients with JoAS even after controlling for multiple covariates including disease duration and gender. No difference in function (BASFI or HAQS scores) between groups was identified.
Compared to AoAS, subjects with JoAS have (1) less severe axial involvement radiographically, (2) similar functional outcomes, (3) more hip involvement with a greater need for THA, and (4) a slightly higher proportion of women.
既往数据表明，青少年起病的强直性脊柱炎（JoAS）患者比成人起病的强直性脊柱炎（AoAS）患者病情更严重，功能预后更差。本研究的目的是在一大群患有长期疾病的患者中评估JoAS和AoAS患者之间的临床、功能和影像学差异。
共有402名符合修订的纽约标准确诊为强直性脊柱炎且病程≥20年的受试者纳入一项多中心横断面研究（强直性脊柱炎预后前瞻性研究；PSOAS）。JoAS定义为初始症状≤16岁。共识别出79名JoAS患者和323名AoAS患者。对两组之间的临床和人口统计学比较进行分析，包括HLA B27状态。通过巴斯强直性脊柱炎功能指数（BASFI）和针对脊柱关节病修改的健康评估问卷（HAQS）评估功能预后。通过巴斯强直性脊柱炎放射学指数（BASRI）评估影像学疾病严重程度。
除发病年龄和病程存在明显差异外，两组的人口统计学和临床特征相似。然而，JoAS组女性比例有升高趋势（32.9%对22.9%，p = 0.07）。在控制包括病程在内的多个协变量后，JoAS组的BASRI髋关节评分和全髋关节置换术（THA）需求均更高。即使在控制包括病程和性别在内的多个协变量后，JoAS患者的BASRI脊柱评分（包括整个脊柱、腰椎和颈椎）仍显著更低。未发现两组之间功能（BASFI或HAQS评分）存在差异。
与AoAS相比，JoAS患者有（1）影像学上轴向受累较轻，（2）功能预后相似，（3）髋关节受累更多，THA需求更大，以及（4）女性比例略高。
