Juvenile Versus Adult-onset Ankylosing Spondylitis — Clinical, Radiographic, and Social Outcomes. A Systematic Review

2013 ◽  
Vol 40 (11) ◽  
pp. 1797-1805 ◽  
Author(s):  
Deepak R. Jadon ◽  
Athimalaipet V. Ramanan ◽  
Raj Sengupta
Keyword(s):  
Systematic Review ◽  
Ankylosing Spondylitis ◽  
Disease Duration ◽  
Age Of Onset ◽  
Joint Involvement ◽  
Adult Onset ◽  
Juvenile Onset ◽  
Observational Study Design ◽  
Radiographic Disease ◽  
Axial Symptoms

Ankylosing spondylitis (AS) has 2 main modes of onset: juvenile-onset AS (JoAS) and adult-onset AS (AoAS). It is not known whether JoAS is a subtype of AS, or AS modulated by early age of onset and longer disease duration. We performed a systematic review of the literature, identifying 12 articles and 1 abstract directly comparing JoAS and AoAS cohorts, with observational study design. Patients with JoAS appear to have more peripheral joint involvement both clinically and radiographically (especially knees and ankles) and more root joint involvement (hips and shoulders); they are more likely to proceed to hip arthroplasty and often initially present with peripheral rather than axial symptoms. Patients with AoAS appear to have more axial symptoms and radiographic disease, particularly in the lumbar spine, and worse axial metrology. In terms of other characteristics, more evidence is needed to confidently state whether JoAS and AoAS are different.

P011 Radiological pattern in juvenile onset Spondylarthritis differ from the adult onset spondylarthritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Hanene Ferjani ◽  
Makhlouf Yasmine ◽  
Kaouther Maatallah ◽  
Dorra Ben Nessib ◽  
Wafa Triki ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Symptom Onset ◽  
Structural Damage ◽  
Disease Duration ◽  
Disease Onset ◽  
Joint Involvement ◽  
Adult Onset ◽  
Juvenile Onset ◽  
Radiographic Features ◽  
The Mean

Abstract Background Spondylarthritis (SpA) is a chronic inflammatory disease of the axial spine that may be affect the peripheral joints. SpA occurs predominantly in adulthood: Adult onset Ankylosing Spondylitis (AoAS). However, it can occur earlier in childhood (≤16 years old), also termed as juvenile onset Ankylosing Spondylitis (JoAS). In the second group, delay in diagnosis may lead to further structural damage. The aim of our study was to compare the differences in radiographic features between JoAS and AoAS. Methods We conducted a retrospective study in our department of rheumatology of Kassab Institute of orthopedics, including patients diagnosed with SpA according to the ASAS criteria (≥17 years at symptom onset) or to the ILAR criteria (≤16 years at symptom onset). Were not included AS patients whose disease onset was ≥ 45 years. Sociodemographic as well as disease characteristics were recorded. The lateral cervical and lumbar spine radiographs were used to assess structural damage by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and The Bath Ankylosing Radiologic Index (BASRI). The total score of mSASSS and BASRI vary between 0–72 and 0–16 respectively with higher scores indicating evolved structural damage. Radiographic features were then compared between AoAS and JoAS. The level of significance was fixed for a P < 0.05. Results Of 140 AS patients, 40 had JoAS and 100 had AoAS. The average age at disease onset was 12.4 ± 3 [8–16] and 25.4 ± 10.1 [17–42] respectively (P < 0.001). The disease duration was 10.6 years [1–44]. The average current age was 25.3 ± 10.2 [9–59] and 32.5 ± 7.5 [18–46] (P < 0.001). The JoAS group showed a more frequent onset with peripheral joint involvement than the AoAS group (80% vs 50%,P = 0.001). Similarly, hip involvement was more frequent among JoAS patients (57.7% vs 25%, P = 0.000). There was no significant differences between the two groups regarding the mean mSASSS score, the total BASRI score and the BASRI score for the sacroiliac joints (P = 0.9, P = 0.49, P = 0.06 respectively). Similarly, there was no differences in the mean spine BASRI score between the two groups, although there was a trend of higher scores among AoAS patients (3.2 vs 3.9, P = 0.15 respectively). On the contrary, JoAS patients had a significantly higher BASRI score for the hip than AoAS patients (2.4 vs 1.3, P = 0.000). Conclusion Our study showed that JoAS patients are more likely to suffer from early hip damage than AoAS patients. The spine BASRI was similar between the two groups despite the shorter disease duration in the juvenile group. This highlights the need for screening for hip involvement and for a closer monitoring in this subset of children.

Comparison of clinical and radiographic severity of juvenile-onset versus adult-onset ankylosing spondylitis

2008 ◽  
Vol 68 (9) ◽  
pp. 1407-1412 ◽  
Author(s):  
F D O’Shea ◽  
E Boyle ◽  
R Riarh ◽  
S M Tse ◽  
R M Laxer ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Symptom Onset ◽  
Disease Duration ◽  
Clinical Course ◽  
Hla B27 ◽  
Adult Onset ◽  
Gender Ratio ◽  
Juvenile Onset ◽  
Neck Stiffness

Objectives:An important unresolved issue in the pathogenesis and clinical course of ankylosing spondylitis (AS) is whether juvenile-onset AS (JoAS) is a clinical entity in its own right or just an earlier onset variant of adult-onset AS (AoAS). A study was undertaken to address this issue.Methods:All patients with AS were extracted from the database of a large spondylitis clinic. Those with symptom onset at ⩽16 years were compared with those with symptom onset at ⩾17 years. Odds ratios (OR) were calculated and adjusted for disease duration and current age.Results:267 patients with AS were identified; 84 met the criteria for JoAS and 183 met the criteria for AoAS. There were no differences in gender ratio (male: JoAS 81%, AoAS 79%) or in HLA-B27 status (positive: JoAS 75%, AoAS 81%). The axial/peripheral pattern of disease at presentation differed; an exclusively peripheral pattern was seen in 26% with JoAS but in only 4.6% of those with AoAS (p<0.001). There were no differences in disease activity between the two groups. When adjusted for disease duration, axial features were more prominent in AoAS than JoAS as represented by neck pain (OR 2.93 (95% CI 1.54 to 5.55)), neck stiffness (OR 3.39 (95% CI 1.80 to 6.39)), back pain (OR 2.96 (95% CI 1.43 to 6.11)) or back stiffness (OR 3.30 (95% CI 1.50 to 7.28)). AoAS was associated with worse functional and quality of life measures and higher fatigue scores when adjusted for disease duration.Conclusions:JoAS follows a distinctive clinical course from AoAS. These clinical features are dictated by factors other than male gender and HLA-B27 and warrant further investigation.

scholarly journals Prediction of generalization of ocular myasthenia gravis under immunosuppressive therapy in Northwest China

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jiaqi Ding ◽  
Sijia Zhao ◽  
Kaixi Ren ◽  
Dan Dang ◽  
Hongzeng Li ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Facial Nerve ◽  
Predictive Factors ◽  
Disease Duration ◽  
Age Of Onset ◽  
Adult Onset ◽  
Juvenile Onset ◽  
Ocular Myasthenia ◽  
Ocular Myasthenia Gravis

Abstract Background It is well demonstrated that immunosuppressants can reduce, but not eliminate the risk of generalized development in ocular myasthenia gravis (OMG). In this study, we aimed to explore the predictive factors of generalized conversion of OMG patients who received immunosuppressive treatments. Methods OMG patients under immunosuppressive treatments in Tangdu Hospital from June 2008 to June 2012 were retrospectively reviewed. Baseline clinical characteristics were documented. Patients were followed up regularly by face-to-face interview and the main outcome measure was generalized conversion. The logistic regression analysis was performed to determine the predictive factors of generalization of OMG. Results Two hundred twenty-three eligible OMG patients completed the final follow-up visit and 38 (17.0%) progressed to generalized MG (GMG) at a median time to generalization of 0.9 year. Patients with adult onset and positive repetitive nerve stimulation (RNS) of facial or axillary nerve had higher conversion rate than those with juvenile onset and negative RNS (p = 0.001; p = 0.019; p = 0.015, respectively). Adult-onset patients converted earlier than juvenile-onset OMG patients (p = 0.014). Upon multivariate logistic regression analysis, age of onset (Odds ratio [OR] 1.023, 95% confidence interval [CI] 1.006–1.041, p = 0.007) and positive facial nerve RNS (OR 2.826, 95%CI 1.045–5.460, p = 0.038) were found to be positively associated with generalized development. Moreover, an obviously negative association was found for disease duration (OR 0.603, 95%CI 0.365–0.850, p = 0.019). Conclusions Age of onset, disease duration and facial nerve RNS test can predict generalized conversion of OMG under immunosuppressive therapy. Adult-onset, shorter disease duration and facial nerve RNS-positive OMG patients have a higher risk of generalized development.

Prediction of myasthenia gravis generalization under immunosuppressive therapy in Northwest China

2020 ◽  
Author(s):  
Jiaqi Ding ◽  
Sijia Zhao ◽  
Kaixi Ren ◽  
Dan Dang ◽  
Hongzeng Li ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Facial Nerve ◽  
Myasthenia Gravis ◽  
Disease Duration ◽  
Age Of Onset ◽  
Immunosuppressive Treatment ◽  
Multivariate Logistic Regression Analysis ◽  
Adult Onset ◽  
Juvenile Onset ◽  
Repetitive Nerve Stimulation

Abstract Objective It is well demonstrated that immunosuppressants can reduce, but not eliminate the risk of generalized development in ocular myasthenia gravis (OMG). Herein, we explored the potential predictors of conversion of OMG patients receiving immunosuppressive treatments. Methods OMG patients under immunosuppressive treatments in Tangdu Hospital from June 2008 to June 2012 were retrospectively reviewed. Baseline clinical characteristics were documented. Patients were followed up regularly by face-to-face interview to evaluate clinic status and treatment efficacy. Main outcome measure was generalized conversion and the relative data were collected and analyzed by logistic regression. Results 223 eligible OMG patients completed the final follow-up visit and 38 (17.0%) progressed to generalized MG (GMG) at a median interval of 0.9 year. Patients with adult onset and positive repetitive nerve stimulation (RNS) of facial or axillary nerve had higher conversion rate than those with juvenile onset and negative RNS ( p = 0.001; p = 0.019; p = 0.015, respectively). Adult-onset patients converted earlier than juvenile-onset OMG patients ( p = 0.014). Upon multivariate logistic regression analysis, age of onset (Odds ratio [OR] 1.023, 95% confidence interval [CI] 1.006–1.041, p = 0.007) and positive facial nerve RNS (OR 2.826, 95%CI 1.045–5.460, p = 0.038) were found to be positively associated with generalized development. Moreover, an obviously negative association was found for disease duration (OR 0.603, 95%CI 0.365–0.850, p = 0.019). Conclusions Age of onset, disease duration and facial nerve RNS test can predict conversion of OMG under immunosuppressive treatment. Adult-onset, shorter disease duration and facial nerve RNS-positive patients have a higher risk of generalized development.

scholarly journals Comparison in clinical features and life impact between juvenile-onset and adult-onset ankylosing spondylitis

2014 ◽  
Vol 44 ◽  
pp. 601-605 ◽  
Author(s):  
Mingqiang GUAN ◽  
Jian WANG ◽  
Zhigang ZHU ◽  
Jun XIAO ◽  
Liang ZHAO ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Clinical Features ◽  
Adult Onset ◽  
Juvenile Onset ◽  
Life Impact

scholarly journals Differences Between Juvenile-onset Ankylosing Spondylitis and Adult-onset Ankylosing Spondylitis

2009 ◽  
Vol 72 (11) ◽  
pp. 573-580 ◽  
Author(s):  
Yi-Chun Lin ◽  
Toong-Hua Liang ◽  
Wei-Sheng Chen ◽  
Hsiao-Yi Lin
Keyword(s):  
Ankylosing Spondylitis ◽  
Adult Onset ◽  
Juvenile Onset

scholarly journals Factors Associated with Radiological Hip Joint Involvement in Patients with Ankylosing Spondylitis

2020 ◽  
Author(s):  
Wei Liu ◽  
Hui Song ◽  
Siliang Man ◽  
Hongchao Li ◽  
Peng Dong
Keyword(s):  
Ankylosing Spondylitis ◽  
Hip Joint ◽  
Associated Factors ◽  
Multivariable Analysis ◽  
Thin Body ◽  
Joint Involvement ◽  
Juvenile Onset ◽  
Cross Sectional ◽  
Factors Associated ◽  
The Mean

Abstract Background: The associated factors for hip involvement in patients with ankylosing spondylitis (AS) are poorly known. This study was to analyze the clinical data of patients with AS and to explore the potential associated factors of AS-related radiological hip joint.Methods: This was a cross-sectional study of patients diagnosed with AS and treated at the Beijing Jishuitan Hospital between 01/2013 and 12/2019. A BASRI-hip score ≥ 2 was defined as radiological hip joint involvement. Univariable and multivariable logistic regression analyses were performed to analyze the factors associated with radiological hip joint involvement.Results: A total of 350 AS patients were included. Patients with radiological hip joint involvement (BASRI-hip ≥2) accounted for 50.6% (177/350). The proportion of men was 83.7% (293/350). The mean age was 35.0±12.7 years old. The mean duration of the disease was 10.8±8.6 years. The HLA-B27 positive rate was 90.9% (318/350). The multivariable analysis showed that the juvenile onset (OR=4.955, 95%CI: 2.464-9.961, P<0.001), bone mass lower than peers (OR=2.862, 95%CI: 1.593-5.142, P<0.001), BMI <18.5 kg/m2 (OR=2.832, 95%CI: 1.321-6.069, P=0.007), BASFI (OR=1.278, 95%CI: 1.069-1.527, P=0.007), and continuous NSAIDs treatment (OR=0.400, 95%CI: 0.200-0.799, P=0.009) were independently associated with radiological hip joint involvement in patients with AS.Conclusion: AS with radiological hip joint involvement had worse body function and lower bone density. The associated factors with radiological hip joint involvement in AS patients included juvenile-onset, thin body size. The prognosis of patients with AS who received continuous NSAIDs drug treatment might be improved.

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