Ankylosing Spondylitis: Early Diagnosis Based on the Natural History

Shoulder, Knee, and Hip Pain as Initial Symptoms of Juvenile Ankylosing Spondylitis: A Case Report

“…Ankylosing spondylitis, sometimes referred to as HLA-B27-related arthritis, Marie-Strumpell's disease, von Bechterew's disease, pelvospondylitis ossificans, and/or rheumatoid spondylitis (1,2,21), is the third most common form of chronic arthritis, affecting as many as 3 million Americans (2). Many health care providers are familiar with the more severe but relatively rare form of ankylosing spondylitis in which the lumbar and t h e rack spinal segments fuse into a "bamboo spine" (2,6,16,(21)(22)(23).…”

“…Many health care providers are familiar with the more severe but relatively rare form of ankylosing spondylitis in which the lumbar and t h e rack spinal segments fuse into a "bamboo spine" (2,6,16,(21)(22)(23). Ankylosing spondylitis is a chronic inflammatory disease most often affecting the axial spine and sacroiliac joints but can affect other joints as well (2,3,5,9,13,16,(21)(22)(23). Early onset of the disease, however, is more frequently associated with peripheral rather than axial joint involvement (2,6,9).…”

“…Ankylosing spondylitis is a chronic inflammatory disease most often affecting the axial spine and sacroiliac joints but can affect other joints as well (2,3,5,9,13,16,(21)(22)(23). Early onset of the disease, however, is more frequently associated with peripheral rather than axial joint involvement (2,6,9). Juvenile ankylosing spondylitis, defined as onset of disease prior to age 16, is considered a pediatric form of ankylosing spondyli tis (4,6,9,21) .…”

“…Early symptoms of ankylosing spondylitis include insidious onset of low back pain (not relieved by rest and often worsening at night), morning stiffness, and occasionally some form of peripheral joint pain (2,13,16,(21)(22)(23). Initial symptoms of juvenile ankylosing spondylitis have been reported to include hip pain or contractures and knee, ankle, or foot pain in the absence of back pain (1,2,5,6,9).…”

“…Initial symptoms of juvenile ankylosing spondylitis have been reported to include hip pain or contractures and knee, ankle, or foot pain in the absence of back pain (1,2,5,6,9). Juvenile ankylosing spondylitis differs from the adult form of the illness in that peripheral joint arthritis or enthesitis is much more common and can precede, by many years, the onset of inflammatory back disease (2,6,9). In addition, functional status may be better preserved in juvenilesnset as opposed to adult-onset cases (4,9).…”