Juvenile Ankylosing Spondylitis: Diagnosis, Treatment, and Management in Children

    juvenile ankylosing spondylitis

    Ankylosing spondylitis (AS) is a type of arthritis primarily affecting the spine, leading to chronic back pain and stiffness. It’s characterized by inflammation in the joints and ligaments of the spine, potentially extending to the peripheral joints. This lifelong condition, while relatively rare, has significant implications for those diagnosed, impacting their mobility, daily activities, and quality of life.

    According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, approximately 0.1% to 0.5% of adults in the United States have AS. While it typically starts in late adolescence or early adulthood, there is a juvenile form of the disease known as juvenile ankylosing spondylitis (JAS).

    What is Juvenile Ankylosing Spondylitis?

    Juvenile Ankylosing Spondylitis (JAS) is a variant of AS that affects children and adolescents. Although it shares many commonalities with adult-onset AS, JAS often presents a unique set of symptoms and challenges due to the ongoing growth and development of the child.

    While comprehensive statistics on JAS are limited, it’s estimated that the disease affects two to three times more boys than girls, and it accounts for approximately 10 to 20 percent of all cases of AS.

    Symptoms of Juvenile Ankylosing Spondylitis

    Juvenile Ankylosing Spondylitis can cause a variety of symptoms in children. These can vary in severity and frequency, and they can appear and disappear over time. Among the most common symptoms are:

    Chronic back pain and stiffness

    This is frequently worse first thing in the morning or after periods of inactivity. The pain usually improves with exercise or movement.

    Joint pain and swelling

    Besides the spine, other joints such as the hips, knees, and ankles can also be affected.


    Children with JAS often feel unusually tired or lack energy.

    Restricted motion

    As the disease progresses, it can lead to a reduced range of motion in the spine and other affected joints.

    Posture changes

    In some cases, JAS can cause changes in posture, such as stooping or hunching over.

    Eye inflammation

    This symptom, known as uveitis, can cause redness, pain, and sensitivity to light.

    Gastrointestinal problems

    Some children with JAS may experience gastrointestinal issues due to associated inflammatory bowel disease.

    Fever and loss of appetite

    In some cases, children may experience low-grade fever and loss of appetite.

    Diagnosing Juvenile Ankylosing Spondylitis

    Diagnosing Juvenile Ankylosing Spondylitis (JAS) can be a complex process, as its symptoms are often similar to those of other conditions. Additionally, children might not always be able to express what they’re feeling, making it harder for healthcare providers to understand their symptoms. Despite these challenges, there are several diagnostic tools and methods that can help identify JAS:

    Medical History

    Typically, the diagnosis process begins with a thorough review of the child’s medical history. Doctors will ask about the child’s symptoms, their duration and severity, and any family history of similar conditions.

    Physical Examination

    During a physical exam, doctors will check for signs of inflammation in the joints. They may also assess the child’s mobility and look for changes in their posture.

    Blood Tests

    Certain blood tests can aid in the detection of inflammation and the exclusion of other conditions. For instance, a test for the HLA-B27 gene can be useful, as most people with AS have this gene. However, having the gene doesn’t necessarily mean a person has or will develop AS.

    Imaging Tests

    X-rays and magnetic resonance imaging (MRI) scans can provide detailed images of the spine and other joints, helping to identify signs of AS like inflammation or structural changes.

    Referral to a Specialist

    If a doctor suspects JAS, they may refer the child to a rheumatologist, a specialist in diseases that cause joint pain and inflammation.

    Treatment Options for Juvenile Ankylosing Spondylitis

    While there’s currently no definitive cure for JAS, the disease can be managed effectively with the right treatment plan. The primary goal of treatment is to reduce symptoms, maintain a normal lifestyle, and prevent potential complications. Here’s a closer look at some of the key components of JAS treatment:

    Nonsteroidal anti-inflammatory drugs (NSAIDs)

    These medications, which include ibuprofen and naproxen, are often the first line of treatment for JAS. They can help to relieve pain and inflammation in the joints.

    Physical therapy

    Regular physical therapy can play a critical role in managing JAS. A physical therapist can teach your child exercises to improve joint flexibility, strengthen back muscles, and maintain good posture. 

    Regular exercise

    Frequent exercise can be helpful in addition to physical therapy as directed. Activities like swimming can be particularly helpful as they’re gentle on the joints while still promoting strength and flexibility.

    Biologic medications

    Biologic drugs might be suggested if NSAIDs are ineffective in a given situation. These medications function by concentrating on particular immune system components that fuel inflammation.

    Holistic approaches

    Alongside medical treatments, holistic approaches can also support overall well-being and symptom management. This could include maintaining a balanced diet, ensuring your child gets sufficient sleep, and teaching them relaxation techniques to help manage pain and stress.

    Navigating Through Juvenile Ankylosing Spondylitis

    Understanding and managing Juvenile Ankylosing Spondylitis can be a challenging journey for both the child and the family. However, children with JAS can lead active and meaningful lives if they receive an early diagnosis and a thorough treatment plan.

    It is important to keep in mind that each child’s experience with JAS is different. Therefore, personalized care that takes into account the child’s symptoms, overall health, and lifestyle is key to managing this condition effectively. This includes medical treatments, physical therapy, regular exercise, and holistic approaches for overall well-being.

    Lastly, don’t hesitate to seek support. Whether it’s from healthcare professionals, support groups, or organizations dedicated to helping families dealing with JAS, remember that you’re not alone in this journey. With the right information and resources, you can navigate through the challenges of JAS and ensure the best possible care for your child.