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A case of childhood-onset ankylosing spondylitis: diagnosis and treatment

Nature Clinical Practice Rheumatology volume 5, pages 52–57 (2009)Cite this article

Abstract

Background A 14-year-old boy with a 6-year history of recurrent arthritis and enthesitis, which had not responded to previous treatment with NSAIDs, sulfasalazine and methotrexate, presented with a severe flare of these symptoms as well as spinal and sacroiliac joint pain. The patient's father had mild psoriasis.

Investigations Counts of tender and swollen joints and tender entheses; assessment of spinal mobility; assessments using the Childhood Health Assessment Questionnaire and the Bath Ankylosing Spondylitis Disease Activity and Functional Indices; measurement of erythrocyte sedimentation rate, serum C-reactive protein level and human leukocyte antigen B27 positivity; radiographs of the sacroiliac joints, hips and feet.

Diagnosis Juvenile-onset ankylosing spondylitis according to the modified New York criteria for ankylosing spondylitis, on the basis of the presence of inflammatory back pain, reduced mobility of the spine and grade 3 bilateral radiographic sacroiliitis.

Management Treatment with NSAIDs, sulfasalazine and methotrexate did not improve the patient's symptoms. Administration of infliximab 5 mg/kg induced a substantial and rapid improvement in all parameters of disease activity.

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Figure 1: X-ray of the patient at age 14 years, demonstrating grade 3 bilateral sacroiliitis.
Figure 2: Composite images of ankylosing tarsitis in a second patient, a 16-year-old boy with 9 years' disease duration and complete ankylosis of the tarsal bones and grade 2 bilateral sacroiliitis.
Figure 3: Coronal T1-weighted MRI of the sacroiliac joints in a third patient with spondyloarthropathy, a 16-year-old boy with a 3-month history of gluteal pain and a 3-year history of peripheral arthritis and enthesitis.

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Acknowledgements

Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Author notes

  1. Hospital General de México and Universidad Nacional Autónoma de México, Dr Balmis 148, México DF 06720, México burgosv@prodigy.net.mx

Authors and Affiliations

  1. R Burgos-Vargas is a Rheumatologist and Researcher in the Rheumatology Department of Hospital General de México and Professor of Medicine (Rheumatology) in the Faculty of Medicine of the Universidad Nacional Autónoma de México, Mexico City, Mexico.,

    Rubén Burgos-Vargas

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Competing interests

R Burgos-Vargas has been a consultant for and received speakers' honoraria from Abbott, Roche, Schering–Plough and Wyeth, and has received grant/research support from Schering–Plough.

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Burgos-Vargas, R. A case of childhood-onset ankylosing spondylitis: diagnosis and treatment. Nat Rev Rheumatol 5, 52–57 (2009). https://doi.org/10.1038/ncprheum0971

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