The Investigation Of Early Clinical Manifestation, Diagnosis Criteria And Prognosis Of Juvenile Ankylosing Spondylitis

Ankylosing Spondylitis (AS) is a rheumatic disease, especially involving spinal column and sacroiliac joint, and it normally starts in the third decade of life. Most of AS patients have inflammatory low back pain, stiffness and limitation of activity. A part of them can involve periphery arthritis and tendon, and have other extra-articular symptoms, such as iridocyclitis. The pathogenic mechanism of AS has not been completely understood yet, now as we know it has a relationship with heredity, immunity and infection. A great of scholars confirm that HLA-B27 intimately correlates with AS, which can be took as clues for the early diagnosis and differential diagnosis of AS. Besides nonsteroidal antiinflamma- tory drugs(NSAIDs) and disease-modifying antirheumatic drugs (DMARDs), in the aspect of therapy , the studying of biological agent has been acquiring satisfactory progression,take anti-TNF for example. Juvenile Ankylosing Spondylitis which occurred before 16 years old, is a common kind of disease in child arthropathy, whose clinical manifestations is similar with AS's. The majority of JAS patients are boys. The reports of clinical characteristics of female patients are rare. We should continue to study. JAS is an independent disease .The study of JAS is behind of AS. Now,we think its pathogenic mechanism is similar with AS's, and also find the pertinency between JAS and HLA-B27.But, JAS has its own features. Usually, the arthritis of peripheral joints especially asymmetry arthritis in low limbs are the first manifestation, either systemic symptoms like fever, iridocyclitis. Physical examination is less sensitive to diagnosis. The radiographic sacroiliitis is not obvious. The SIJ of children is developing, so it is a limitation of the check of iconography. Nowadays, doctors diagnose JAS still according to New York diagnose criterion, as it insist the symptom of back and lumbus and the sacroiliac which were double andⅡdegree or exceedⅡdegree, the criterion is disbennifit for early diagnose. JAS is a chronic rheumatic disease, but it often involves hip joints which can lead to deformity.In order to investigate the clues of early diagnosis of JAS, We choosed 46 cases of JAS that have full case in our department and 6 cases of orthopedics patients from January of 1994 to December of 2008,and had a retrospective analysis among of them.3 cases are girls.34 cases(65.38%)had peripheral joints gall, most of them is coax and knee.7 cases ( 13.46% ) have thews end inflammatory and thenar pain。6 cases (11.54%)had stiffness and pain of back,3 cases(5.77%)have gluteal region pain. 2 cases (3.85%) have neck pain. All the patients have SIJ CT,5 cases(9.62%)Ⅰdegree. There have 47 cases (90.38%) that HLA-B27 positive.27 cases (51.92%) that the level of CRP is higher than normal, ESR is quicker than normal, average value is 49mm/h. 7cases have been mistaken juvenile rheumatoid arthritis (JRA), 6 cases have been mistaken tuberculosis of bone joints, 1 case has been mistaken growth pain, 1 case has been mistaken myositis, 1 case has been mistaken rheumatic fever, 1 case has been mistaken Femur Head Nerosis .1 case has been mistaken herniated lumbar disc, the early diagnosis of 3 cases are Juvenile-onset Spondyloarthropathy and 31 cases diagnosis were not clear. The rate of missed diagnosis is 82.69%.We treat with ibuprofen (Fenbid), methopterin, total Glucosides of Paeony, course of treatment is more than 3 months. 10 cases (19.23%)were catabatic,28 cases(53.85%)were partly catabatic, 14 cases(26.92%)were disabled.According to the data of this article, we think that JAS is more common in boys, the early clinical manifestations includes peripheral arthritis, especially the joints of the lower limbs, like coax , knee, ankle. It has been distinguished to tuberculosis of bone joints, JRA, growth pain and myositis et al. The cases of lumbosacral region pain is easy to diagnosis. The part of undifferentiated spondyloar- thritides patients can diagnosis JAS after long term follow-up. It has striking association between JAS and HLA-B27 which can be established by the rate (86.67%)of HLA-B27 positive in our study. According to the study of abroad and our experience, we think that checking HLA-B27 is more important in diagnosis of JAS than in adult AS. Now we have no unified diagnostic criteria of JAS. The diagnostic criteria of JAS we use now insist the sacroiliac which were double andⅡdegree or exceedⅡdegree, it's disbennifit for early diagnosis. Domestic scholars suggest take MRI as diagnostic criteria too. But MRI is expensive, and we have no enough clinical experien- ces.Conclusions: The early clinical manifestation of JAS includes peripheral arthritis, especially coax and knee, thews end inflammat- ory and thenar pain and stiffness and pain of back, includes systemic symptoms like fever. HLA-B27 is positive ,CRP or ESR can be abnormal. But because the radiographic sacroiliitis is not obvious ,and no special diagnostic criteria, it's easy to misdiagnose. So we must emphasize: To those children who have peripheral arthritis and thews end inflammatory and thenar pain as the first clinical manifestation, doctor should remember to enquire the family history of spondylo- rthropathy, test HLA-B27, check sacroiliac joint CT or MRI, the undifferentiated Spondyloarthropathies patients should follow up, so that diagnosis it in the first time and therapy, reduce disability ratio. And we suggest institute special criteria for JAS.