Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
J Chin Med Assoc. 2009 Nov;72(11):573-80. doi: 10.1016/S1726-4901(09)70432-0.
Ankylosing spondylitis (AS) is a chronic inflammatory disease, which involves the spine, peripheral joints and entheses. Juvenile-onset ankylosing spondylitis (JAS) affects children under the age of 16 years. JAS has been noted to present as clinical courses different from those of adult-onset ankylosing spondylitis (AAS). Therefore, the purpose of the present study was to compare the possible risk factors, clinical manifestations, laboratory markers, radiological changes, and functional outcome between these 2 patient groups.
AS patients were enrolled from the rheumatologic clinic of a tertiary medical center from January 1 to June 30 in 2006. The demographic data, clinical symptoms/signs, Bath AS indices, HLA-B27, inflammatory markers, radiological findings, and treatment history were acquired with questionnaires, clinical evaluation, and chart review. The differences between JAS and AAS patients were evaluated and analyzed.
A total of 169 patients (142 males, 27 females) were included, comprising 47 JAS and 122 AAS patients. The ages of onset were 12.8 +/- 2.7 years and 25.0 +/- 7.4 years for JAS and AAS, respectively. They had similar gender distribution, years of delay to diagnosis and disease duration. A substantial proportion of our patients (40.4% of JAS and 34.4% of AAS) had physical trauma in the 1 month before disease onset. Also, 22.7% of JAS patients had intense physical training, while 25.2% of AAS patients did heavy work during the period. The first manifestation of JAS was mainly peripheral enthesopathy or arthritis, but axial symptoms in most AAS. More JAS patients had peripheral enthesopathies and arthritis on any occasion. Although there was a trend of higher score in Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI) and Physician's Global Assessment (PGA) score, JAS patients had a comparable Bath AS Functional Index (BASFI) and Bath AS Patient's Global Assessment (BAS-G) as AAS patients. As to the laboratory and radiological tests, JAS patients had higher levels of C-reactive protein and erythrocyte sedimentation rate, and more radiographic changes of hip joints.
JAS and AAS patients had distinct presentations. JAS presented more peripheral enthesopathies and arthritis at disease onset and at any time of the course. If treated effectively, JAS will not lead to a worse functional outcome than AAS. Therefore, it is mandatory to diagnose and treat JAS as early as possible.
强直性脊柱炎（AS）是一种慢性炎症性疾病，涉及脊柱、外周关节和附着点。青少年发病的强直性脊柱炎（JAS）影响 16 岁以下的儿童。已经注意到 JAS 的临床表现与成人发病的强直性脊柱炎（AAS）不同。因此，本研究的目的是比较这两组患者的可能危险因素、临床表现、实验室标志物、影像学变化和功能结局。
2006 年 1 月 1 日至 6 月 30 日，从三级医学中心的风湿科招募 AS 患者。通过问卷调查、临床评估和病历回顾获得人口统计学数据、临床症状/体征、巴斯强直性脊柱炎指数、HLA-B27、炎症标志物、影像学发现和治疗史。评估和分析 JAS 和 AAS 患者之间的差异。
共纳入 169 例患者（男性 142 例，女性 27 例），包括 47 例 JAS 和 122 例 AAS 患者。JAS 和 AAS 的发病年龄分别为 12.8±2.7 岁和 25.0±7.4 岁。它们具有相似的性别分布、诊断延迟年限和疾病持续时间。我们的患者中有相当一部分（JAS 为 40.4%，AAS 为 34.4%）在疾病发作前 1 个月有身体创伤。此外，22.7%的 JAS 患者有剧烈的体能训练，而 25.2%的 AAS 患者在发病期间从事重体力劳动。JAS 的首发表现主要为外周附着点病或关节炎，但大多数 AAS 以轴性症状为主。JAS 患者在任何时候都有更多的外周附着点病和关节炎。尽管 JAS 患者的巴斯强直性脊柱炎疾病活动指数（BASDAI）、巴斯强直性脊柱炎测量指数（BASMI）和医生全球评估（PGA）评分有升高趋势，但 JAS 患者的巴斯强直性脊柱炎功能指数（BASFI）和巴斯强直性脊柱炎患者全球评估（BAS-G）与 AAS 患者相当。至于实验室和影像学检查，JAS 患者的 C 反应蛋白和红细胞沉降率水平较高，髋关节的影像学改变也较多。
JAS 和 AAS 患者的表现不同。JAS 发病时和病程中更常出现外周附着点病和关节炎。如果治疗有效，JAS 不会导致比 AAS 更差的功能结局。因此，必须尽早诊断和治疗 JAS。
