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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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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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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DOI: https://doi.org/10.1038/ncprheum0971