Juvenile ankylosing spondylitis: definition, symptoms, and treatment

Juvenile ankylosing spondylitis (JAS) is a form of inflammatory arthritis that occurs in children and young adults. It mainly affects the spine, but can also affect the enthesis, where the tendons and ligaments meet the bone.

JAS can affect other organs and areas of the body as well.

According to the Arthritis Foundation (AF), JAS is more common in men and has a genetic component. If someone in the immediate family has JAS, then a child is more likely to develop the disease.

In this article, we examine the causes, symptoms, risk factors, diagnosis, treatments, and outlook for a person with JAS.

JAS is an inflammatory condition that primarily affects the spine but can also cause pain in the hips, knees, or heels when it starts.

“Youthful” refers to a young person. “Spondyl” is another term for vertebrae and “ankylosing” means stiff.

According to an article in the Journal of Rheumatology, ankylosing spondylitis has two forms of onset: juvenile and adult.

Healthcare professionals diagnose juvenile onset ankylosing spondylitis if patients develop symptoms before they are 16 years old.

JAS causes inflammation in the joints and entheses. This can cause pain in your hips, knees, heels, back, or buttocks.

As it progresses, bones in the spine can fuse, causing stiffness. Chest bones can also fuse, which can make breathing difficult.

JAS can also affect the eyes. Chronic eye inflammation or uveitis can cause pain, redness, dryness, blurred vision, and sensitivity to light.

Chronic inflammation in the gastrointestinal tract can also lead to inflammatory bowel disease, which leads to diarrhea and abdominal pain.

When nerves become pinched in the back, you may experience weakness or numbness in the legs, or pain in the buttocks and thighs.

Learn more about the effects of ankylosing spondylitis and how to treat it here.

A 2013 review found that symptoms usually begin by the time a person hits their 20s. However, 18% of cases develop earlier. Doctors refer to this as juvenile onset.

Symptoms generally develop slowly over several weeks or a month. They vary widely but start with pain in the hips, knees, or heels. Next, you may experience lower back and buttock pain.

The Philadelphia Children’s Hospital notes that the most common symptoms of JAS are:

  • Stiffness when waking up or after being inactive
  • Pain in the buttocks or back that gets better with activity
  • Pain in the knees, heels, or the soles of your feet that worsen with activity
  • abdominal symptoms such as weight loss, diarrhea, and pain
  • Eye pain, redness, and sensitivity to light
  • Swelling and warmth in the joints of the lower extremities
  • Difficulty standing or bending over to touch the toes

Other symptoms are:

  • Back pain that occurs in the morning or at night
  • shortness of breath
  • fatigue
  • light fever
  • Loss of appetite
  • Pain, swelling, and warmth in the following parts of the body:
    • Toes
    • ankle
    • paragraphs
    • knee
    • buttocks
    • upper spine
    • Rib cage
    • neck
    • Shoulders

The symptoms of JAS can be similar to many other health conditions. For the correct diagnosis, it is important to consult a pediatrician.

Health professionals do not know the exact cause of JAS. However, the condition is closely linked to a genetic marker known as HLA-B27.

About 80–90% of children and adolescents with JAS have the HLA-B27 gene.

It is possible that children with the JAS gene will develop if they are exposed to a virus, bacteria, or other environmental condition.

However, not everyone with this gene will develop JAS.

Men are two to three times more likely to develop JAS than women.

The University of Rochester Medical Center advises that if a family member has ankylosing spondylitis, there is a higher risk of developing JAS.

A child or adolescent is also at a higher risk if they carry the HLA-B27 gene marker.

A doctor will ask for a detailed medical history, including information about family members. It is important to let them know if there is a family history of ankylosing spondylitis.

To do a physical exam, the doctor may ask the child to move around in certain ways to check the flexibility of their spine. You can also do non-invasive tests to check the child’s nervous system.

The doctor or nurse may then order more tests or scans to assess the possibility of JAS. These could include:

  • an x-ray of the spine or pelvis
  • an MRI of the spine or pelvis
  • an ultrasound
  • Blood tests

Blood tests can look for an antigen that indicates the presence of the HLA-B27 gene marker. This gene has been linked to an increased risk of developing JAS.

Medically-guided treatment for JAS can include medication, physical therapy, exercise, or surgery.

Medication

There are several types of medication available to treat JAS. These include:

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): This can include non-prescription or prescription drugs.
  • Disease-Modifying Anti-Inflammatory Drugs (DMARDs): Drugs like sulfasalazine and methotrexate prevent the immune system from causing inflammation in the joints.
  • Biologics: These are a type of DMARD that disrupt the inflammatory process and help prevent flare-ups.
  • Corticosteroids: Examples are prednisone. These are fast-acting anti-inflammatories. However, a doctor can only recommend this for limited use in children due to possible side effects.

Physiotherapy or occupational therapy

Physical therapy exercises can help strengthen the body and keep the spine flexible.

An occupational therapist can provide support equipment and training that simplify day-to-day functions.

a practice

As an important part of treating JAS, a doctor may prescribe gentle exercise to help maintain flexibility and build strength.

Hiking, yoga, biking, and swimming are often options. Stretching is also a way of maintaining flexibility and function in the joints.

surgery

Surgery is rare in JAS, but occasionally joint replacements or spinal surgery can help to relieve the pain.

There is no cure for JAS. However, a person can manage the symptoms. Some people may choose to try alternative or natural treatments in addition to medical treatments.

Some of these options include:

acupuncture

This traditional therapy focuses on piercing very fine needles into treatment points in the skin. The needles can help release the body’s natural pain relieving hormones.

Alexander Technique

This movement system teaches a person how to improve their posture to increase functionality. It helps a person become more aware of their body and how they move, sit and stand.

The goal is to focus on the relationship between the head, neck, and spine and how they work to keep the body functioning well.

Message therapy

Massage therapy should start gently as it can cause some people to flare up their condition.

However, for others, it can provide relaxation and pain relief. It can even improve blood circulation and reduce stiffness in some areas.

TENS unit

TENS stands for transcutaneous electrical nerve stimulation. It is a control unit that is attached to the skin with wires and adhesive electrodes.

The control unit supplies the body with short electrical current impulses of varying strength, frequency and duration.

According to the National Axial Spondyloarthritis Society, electrical stimulation from a TENS machine can affect the way the brain receives pain signals. It can also cause the brain to release pain relieving endorphins.

Establishing a self-care system at home is important in managing chronic conditions. To manage the symptoms of JAS, self-care should focus on:

diet

Because JAS is an inflammatory condition, a diet high in anti-inflammatory foods can be beneficial.

Fruits, vegetables, whole grains, oily fish, and other elements of the Mediterranean diet are good choices along with limiting sugars and fats.

attitude

Good posture can help relieve pain and reduce stiffness.

When working at a desk, a person may get up and move once an hour for several minutes. You can adjust the chair so that the computer monitor is at eye level. You can also hold up cell phones so that your neck is upright as you read the screen.

support

Living with a chronic illness can feel isolating. Friends and family can provide support through listening and physical help.

For teenagers, the AF offers the iPeer2Peer program, which brings together mentors for young adults with arthritis and teenagers with JAS. Some may also benefit from speaking with a licensed therapist.

JAS is a progressive disease and several possible complications can arise, including:

  • Joint damage
  • Fusion of the spine or rib cage
  • Kyphosis, the forward curvature of the spine
  • Difficulty breathing due to fusion of the chest bones
  • Fractures
  • Heart, eye and kidney problems

Early diagnosis and ongoing care by a doctor will help resolve any complications that may arise.

The outlook for JAS varies from person to person.

Some people have chronic symptoms, some have intermittent flare-ups of symptoms, and some will persist for an extended period of time when the disease is in a mild or inactive state.

A 2016 review found those with JAS had a lower chance of achieving remission than those with other types of juvenile arthritis. The authors point out that studies have found that less than 20% of children experience remission from JAS if disease activity lasts for more than 5 years.

Some things that can help someone manage the symptoms are:

  • stay active
  • have a good rest
  • eat a healthy and balanced diet

Smoking can increase the risk of complications. People with JAS should not smoke or try to quit smoking.

If a child has back pain, joint pain, or morning stiffness, a caregiver should see a doctor.

For a child diagnosed with JAS, a caregiver should see a doctor if the child experiences:

  • Eye symptoms
  • Difficulty breathing
  • new or worsening symptoms

JAS is chronic inflammatory arthritis that causes pain in the spine and the joints between tissues and bones. It can cause bones in the spine and chest to fuse together, causing stiffness and problems with deep breaths.

Symptoms can include pain and stiffness in the back, buttocks, heels, knees, or other joints. It can also affect the eyes and gastrointestinal system.

Treatment for JAS includes medication, physical therapy, exercise, and very rarely surgery. The aim is to maintain flexibility and mobility.

Some people with JAS may experience symptoms all the time, while others have them from time to time or, if ever, rarely.