Ankylosing Spondylitis Ankylosing spondylitis (AS) is a condition that mainly affects the joints in the spine. Inflammation in the affected area of the spine causes pain and stiffness. As it progresses, new bone may grow into the spinal joints, causing the area to fuse into a permanent position (i.e., the joints are no longer able to move). The affected area of the spine may move forward, causing a stooped posture.

Some patients with AS also experience problems in other areas of the body, like the shoulders, ribs, hips, hands, feet and heels. The condition can also cause eye inflammation or an irregular heart rhythm.

AS most commonly is diagnosed between 17 and 35. Men are affected more often than women. The condition appears to have some genetic basis. About 95 percent of patients with AS have a genetic marker, called HLA-B27.

AS in Children Although AS is more commonly diagnosed in young adults, it can occur at any age - including during childhood. But sometimes the symptoms are overlooked or misdiagnosed (sometimes mistaken for "growing pains" or tendonitis). The problem stems from the fact that signs of juvenile AS vary greatly in children. Some young patients have only mild symptoms. In addition, the symptoms may come and go without any obvious pattern. Children with AS may also develop fever, psoriasis or digestive problems (colitis or Crohn's disease). Family history of AS, X-rays, the presence of the HLA marker and the history of symptoms are suggestive of juvenile AS.

Early Diagnosis and Treatment of Children with AS Recent research shows one in eight adults with AS actually had symptoms that began during childhood, but patients were not diagnosed until later in life. Patients who develop signs of AS in childhood take an average of 15.5 years to get an accurate diagnosis. When symptoms develop during adulthood, it takes about 7.6 years to reach the diagnosis. The later diagnosis for children means many young patients aren't getting appropriate care for their condition. Researchers have found children with AS who are not diagnosed until adulthood tend to have greater levels of disability as adults compared to patients who don't develop symptoms until adulthood.

Once children are properly diagnosed, there are several different treatment options. Exercise and physical therapy are important to maintain range of motion and prevent stiffness. Medications are similar to those used for adults. Nonsteroidal anti-inflammatory drugs and disease modifying anti-rheumatic medications are important treatments. Three of the newest drugs for AS are etanercept (Enbrel®), infliximab (Remicade®) and adalimumab (Humira®).

American College of Rheumatology, http://www.rheumatology.org The Arthritis Foundation, http://www.arthritis.org Spondylitis Association of America, http://www.spondylitis.org, or call 800-777-8189