Juvenile Ankylosing Spondylitis Research Articles

AYURVEDIC MANAGEMENT OF JUVENILE ANKYLOSING SPONDYLITIS: A CASE STUDY

A 16year old boy, who wasdiagnosed with Juvenile Ankylosing Spondylitis treated with a combination of Panchakarma procedures and Ayurvedic medicines(Integrative approach). The patient was considered suffering from Aamavata(∼Vata disorder involving bone and joints) and was treated based on fundamentals of treatment as mentioned by ayurvedic texts. Patients condition was assessed every 7 days initially for 1 monthend later monthly.Thescore sets of Assessment of Spondylo Arthritis BASDAI and ASDAS score and symptoms showed substantial improvement after 120 days of treatment.

An Unexpected Outcome in an Adolescent With Juvenile Ankylosing Spondylitis

An Unexpected Outcome in an Adolescent With Juvenile Ankylosing Spondylitis

Ентезопатії при анкілозивному спондиліті, що почався в дитячому та дорослому віці

Актуальність. Поширеність анкілозивного спондиліту (АС) серед населення досягає 0,3 %, який значно частіше розвивається у віці 20–30 років. Виділяють дві форми АС — дитячу і дорослу, залежно від віку дебюту захворювання. Проблема діагностики ювенільного АС (ЮАС) належить до найбільш актуальних у педіатричній ревматології, при цьому еволюція такого захворювання в дорослому віці залишається невивченою. ЮАС розглядають як ентезитасоційований артрит, що спостерігається у 10–20 % від загального числа хворих. Мета дослідження. Вивчити у хворих на АС частоту й клінічні ознаки перебігу ентезопатій, оцінити їх особливості при захворюванні, що почалося в дитячому та дорослому віці. Матеріали та методи. Обстежено 217 хворих на АС (193 чоловіки і 24 жінки), середній вік 38 років. Швидкопрогресуючий перебіг констатований у 21 % спостережень, помірний й високий ступінь активності — у 79 %, ІІ–ІІІ стадія — у 82 %, поліартрит — у 65 %. ЮАС відзначено в 16 % випадків (усі хлопчики), у цих пацієнтів ІІІ стадія мала місце удвічі частіше, ніж у інших пацієнтів. Результати. Ентезопатії спостерігаються у 39 % від загального числа хворих на АС, в 3,1 раза частіше у випадках ЮАС, для якого характерні тарзити, ураження сухожиль чотириголового м’яза, виростків стегнової кістки, місць прикріплень до хребців і ребер, а для захворювання, що почалося в дорослому віці, не типове залучення ахіллових сухожиль, причому прогнознегативними ознаками відносно ентезитів і тендовагінітів вважаються поширеність периферійного артикулярного синдрому, параметри інтегрального індексу активності артриту та індексу Лансбурі, артрит гомілковоступневих, кульшових і дуговідростчастих зчленувань, наявність остеоузур та артрокальцинатів, а в патогенетичних побудовах ентезопатій беруть участь імунні порушення, при цьому загальним для АС з різним віковим дебютом хвороби є вираженість в хребцях синдесмофітів й спондилоартрозу, а у випадках захворювання дорослих, окрім того, наявність епіфізарного остеопорозу і остеоузур. Висновки. ЮАС є чинником ризику розвитку ентезопатій, які у хворих з різним віковим дебютом захворювання мають свої клініко-патогенетичні особливості перебігу.

Juvenile spondyloartropathies.

Juvenile spondyloarthropathies (JSpA) are defined as a heterogeneous group of diseases that start before the age of 16, which is associated with peripheral joint (especially large joints of the lower limbs) and axial skeletal (spine and sacroiliac joint) involvement, enthesitis, and human leukocyte antigen (HLA) B27 positivity. Juvenile spondyloarthropathies mainly cover juvenile ankylosing spondylitis (JAS), psoriatic arthritis, reactive arthritis, inflammatory bowel disease-associated arthritis, seronegative enthesopathy, arthropathy syndrome (SEA), and enthesitis-associated arthritis. Symptoms associated with spondyloarthropathies are enthesitis, inflammatory low back pain, dactylitis, nail changes, psoriasis, acute anterior uveitis, and inflammatory bowel disease-related symptoms. In JSpA, axial involvement is rarely seen in the early stages of the disease, in contrast to adult patients with ankylosing spondylitis (AS). The disease usually begins as asymmetric oligoarthritis of lower extremities in children, and axial skeletal involvement can occur in the course of the disease. Although the debate on the classification of juvenile spondyloarthropathies continues due to its initial nonspecific findings and the heterogeneity of the disease phenotype, the International League of Associations Rheumatology (ILAR) classification criteria are the most commonly used pediatric criteria. In that set of criteria, patients with JSpA are mainly classified under enthesitis-related arthritis or psoriatic arthritis group. Since juvenile spondyloarthropathies can cause severe loss of function and long-term sequelae, the main goal in treatment should be suppression of inflammation as early as possible and prevent sequelae.

Ювенильный анкилозирующий спондилит (обзор литературы и собственные данные)

Представлены обзор современной литературы и данные собственных обследований 35 детей и 182 взрослых, страдающих анкилозирующим спондилитом. По сравнению с заболеванием у взрослых людей ювенильный анкилозирующий спондилит (ЮАС) имеет целый ряд особенностей клинического течения, который возникает исключительно у мальчиков, проявляется более частым поражением осевых суставов (плечевых, тазобедренных), развитием системного остеодефицита (остеопении, остеопороза), энтезитов (в частности, мыщелков бедренной кости и позвонковых сочленений, но не ахиллодинитов), увеита и кардиопатии, пролиферацией (а не деструкцией) участков кости в дебюте спондилопатии и редким вовлечением в процесс поясничного отдела позвоночника и формированием эпифизарного остеопороза, более высокими концентрациями в крови интерлейкинов-8 и -17, но меньшими значениями интерлейкина-1β, циркулирующих иммунных комплексов, фибриногена, иммуноглобулинов А и G. Возможно, будет целесообразным выделение ЮАС в отдельную нозологическую форму, как, например, ювенильного идиопатического артрита (в недавнем прошлом — ювенильного ревматоидного артрита).

Do geography and ethnicity play a role in juvenile Spondyloarthritis? A multi-center binational retrospective study

BackgroundObservations among Israeli pediatric rheumatologists reveal that pediatric Juvenile Spondyloarthritis (JSpA) may present differently compared to patients from the United States (US). This study is aimed to compare the demographic and clinical variables of Israeli and US JSpA patients upon presentation.MethodsWe performed a retrospective, cross-sectional, multicenter comparison of JSpA patients among 3 large Israeli pediatric rheumatology centers and a large US pediatric rheumatology center. Patients with diagnosis of Juvenile Ankylosing Spondylitis (JAS) and/or Enthesitis-related Arthritis (ERA) were included. The demographic, clinical and radiologic features were compared.ResultsOverall 87 patients were included (39 Israeli, 48 US patients). Upon presentation, inflammatory back pain, sacroiliac joint tenderness and abnormal modified Schober test, were significantly more prevalent among Israeli patients (59% vs. 35.4, 48.7% vs. 16.7, and 41.2% vs. 21.5%, respectively, all p < 0.05), whereas peripheral arthritis and enthesitis were significantly more prevalent among US patients (43.6% vs. 91.7 and 7.7% vs. 39.6% in Israeli patients vs. US patients, p < 0.05). In addition, 96.7% of the Israeli patients versus 29.7% of the US patients demonstrated sacroiliitis on MRI (p < 0.001, N = 67). Less than one-third of the Israeli patients (32%) were HLA-B27 positive vs. 66.7% of US patients (p = 0.007).ConclusionIsraeli children with JSpA presented almost exclusively with axial disease compared to US patients who were more likely to present with peripheral symptoms. HLA B27 prevalence was significantly lower in the Israeli cohort compared to the US cohort. Further studies are needed to unravel the genetic and possibly environmental factors associated with these findings.

Expression and clinical significance of plasma microRNA-766 in children with polyarticular juvenile idiopathic arthritis

Objective To discuss the expression and clinical significance of microRNA(miR)-766 in children with polyarticular juvenile idiopathic arthritis (poly-JIA). Methods A total of 23 children with poly-JIA who received treatment at the Department of Rheumatology, the Affiliated Children′s Hospital of Capital Institute of Pediatrics, from November 2014 to September 2016, were enrolled as research group, and 24 healthy children at the same age were selected as healthy control group, while 24 children with oligoarticular juvenile idiopathic arthritis (oligo-JIA) and 19 children with juvenile ankylosing spondylitis (JAS) were selected as case-control groups.The expression levels of miR-766 in plasmas were detected by real-time quantitative polymerase chain reaction (qPCR). The clinical diagnostic values were analyzed by operating characteristic curve (ROC). Correlations between the expression levels of miR-766 and clinical, laboratory results were analyzed by conducting Pearson correlation coefficient analysis. Results Compared with the healthy control group and case-control group, the expression levels of miR-766 in poly-JIA group decreased, and the differences were statistically significant (t=6.897, 6.446, 6.218, all P 0.05). Compared with the healthy control group, the area under ROC curve of miR-766 was 0.938 (95%CI: 0.872-1.000), and when the cutoff value of miR-766 was 6.083 pmol/L, the sensitivity was 87.0% and the specificity was 91.7%.Compared with oligo-JIA and JAS, the area under ROC curves of miR-766 was 0.908 (95%CI: 0.819-0.996) and 0.927 (95%CI: 0.865-1.000), respectively.Correlation analysis indicated that the level of miR-766 in plasma of poly-JIA children was positively associated with hemoglobin (r=0.651, P<0.001), but negatively asso-ciated with the 28-joint Disease Activity Score (DAS28) and the percentage of type 1 helper T cells(Th1%) (r=-0.434, P=0.038; r=-0.417, P=0.008). Conclusions The expression levels of plasma miR-766 in poly-JIA are significantly decreasing.miR-766 may serve as an evaluation indicator for the diagnosis and prognosis of poly-JIA. Key words: Polyarticular juvenile idiopathic arthritis; MicroRNA-766; Diagnosis; Child

Disturbance of the muscoloskeletal system in juvenile ankylosing spondylitis and disease developed in the adulthood (involvement of spine and sacroiliac joints).

Background. Two forms of ankylosing spondylitis (AS) are distinguished: juvenile and adult, depending on debut age of the disease. The diagnosis of juvenile AS (JAS) is one of the most urgent problems in a pediatric rheumatology. The peculiarities of AS course that onsets in childhood and adulthood are manifested by differences in the nature of a spinal column disturbance. At the same time, the evolution of JAS in adulthood remains unexplored. The goals and objectives of research: to study clinical and X-ray symptoms of spondylopathy and sacroiliitis course, to assess their characteristics in the disease that onset in childhood and adulthood. Material and methods. 217 patients with AS (193 men and 24 women) with an average age of 38 years were examined. The fast-progressing course of the disease was detected in 21% of cases, moderate and high degree of activity – in 79% of cases, the ІІ-ІІІ stage in 82%, and polyarthritis – in 65%. JAS was detected in 16% of cases (all boys), among them the third stage occurred twice more likely than among the other patients. Results. The clinical and radiologic signs of spondylopathy and sacroiliitis are observed in 95% and 97% of the total number of AS cases, respectively, among all patients with JAS lumbago was detected 4,3 times more frequently, sciatic muscles hypotrophy – 7,8 times, "the string symptom" - 2,9 times", the calcification of the spinal cord - 2,3 times, whereas the prevalence of spinal column injury, the severity of cervico-spondylopathy and sacroiliitis among patients with the disease debut in the adulthood is significantly greater, and the involvement in the process of the lumbar and thoracic spine are detected correspondingly twice as often and by 19%, occurrence of dorsalgia is 4 times as often, the limitation of body lateral bendover by 59%, while there are ambiguous dispersion-correlation links with extraarticular (systemic) manifestations of the disease, and the high prevalence of a peripheral articular syndrome regarding spondylopathy in JAS is a negative prognosis sign, and for the remaining patients there are indices of the Lansbury index and the index of arthro­pathy progression. Conclusion: the onset of AS in adulthood is a risk factor for the severe course of spondylopathy.

THU0170 Efficacy and Safety of Infliximab in Juvenile Idiopathic Arthritis and Juvenile Ankylosing Spondylitis

ObjectivesThis study will provide evidence-based medical evidence in the application of infliximab for pediatric rheumatology.MethodsThe 45 cases of this study were allocated to treatment group and control group. The treatment...

PReS-FINAL-2115: Differences in musculoskeletal clinical expression between Spanish and Mexican patients with juvenile spondyloarthritis: data from the Mexespa project

Juvenile spondyloarthritis (J-spa) is characterized by a predominantly peripheral involvement and more frequent presentation as undifferentiated forms. However, like its adult-onset equivalent, it has the potential to develop structural damage and evolve to juvenile ankylosing spondylitis (J-AS), with consequent functional impairment that will last for the lifetime of the patient. Although descriptions of jspa in worldwide different populations are scarce, it has been suggested that clinical expression could be different in Spanish and Mexican patients.

Relationship between specific microRNAs in plasma and juvenile idiopathic arthritis

Objective To investigate the potential possibilities of specific microRNA in plasma as novel biomarkers for the early diagnosis in juvenile idiopathic arthritis(JIA). Methods This research was be segmented into 4 stages.1. Screened candidate microRNAs: 5 candidate plasma microRNAs were detected by biochips of microRNAs, corresponding 5 JIA patients with onset of oligoarthritis, 5 JIA patients with onset of polyarthritis and 3 age-matched and sex-matched healthy controls individual.2. The feasibility of the microRNAs as novel biomarkers was validated by Real-time quantitative polymerase chain reaction (RT-PCR) in plasma on 80 JIA patients (43 oligoarthritis, 37 polyarthritis), 29 juvenile ankylosing spondylitis(JAS) patients and 30 healthy control individuals.3. The change of microRNAs was observed by RT-PCR in plasma from another 9 JIA patients before and 3 months after anti-rheumatic drug treatment.4. The correlation between the levels of candidate plasma microRNAs and clinical parameters of JIA patients was analyzed. Results Plasma concentrations of miR-16, miR-146a and miR-223 in JIA patients, including oligoarthritis and polyarthritis, were significantly higher than those in healthy subjects (all P 0.05). More importantly, it was found that the expression of miR-16 was considerably reduced in the post-treatment plasma samples when compared to the pre-treatment samples(P=0.061). In addition, the levels of miR-16 in JIA plasma inversely corrected with tender joint. Conclusions Plasma levels of miR-16 were well-discriminated between JIA patients and healthy subjects or JAS patients. It is suggested that plasma miR-16 might serve as a novel and potential biomarker for screening JIA. Furthermore, it might serve as a novel biomarker for joint inflammation but not specifically for differentiating the subtypes of JIA. Key words: MicroRNA; Juvenile idiopathic arthritis; Biomarker

Different clinical features in patients with ankylosing spondylitis from southern and northern China

To describe clinical features of patients with ankylosing spondylitis (AS) from southern and northern China, and investigate the effects of onset age, gender and regional differences on disease phenotype. Totally 113 AS patients from southern China and 121 AS patients from northern China were analyzed retrospectively. In southern and northern groups, low back pain was more frequent among initial symptoms (54.9% vs. 7.7%; 52.4% vs. 11.4%), while peripheral arthritis (15.7% vs. 35.9%; 22.2% vs. 68.6%) was less common in male adult AS (AAS) than in male juvenile AS (JAS) patients, respectively. Compared to those in the northern group, diagnostic delay was longer (7.3 vs. 3.5 years) and the prevalence of human leukocyte antigen (HLA)-B27 was higher in the southern group (96.5% vs. 83.5%). Sacroiliitis grade 2 was more frequent (51.3% vs. 36.4%), while sacroiliitis grade 3 (32.7% vs. 53.7%), buttock pain (5.3% vs. 13.2%), knee (20.4% vs. 33.1%) and ankle (3.5% vs. 11.6%) arthritis were less frequent in the southern group. Diagnostic delay of southern JAS was longer than that of northern JAS regardless of gender. Both sacroiliitis grade 3 and peripheral arthritis were less frequent in southern male JAS than in northern male JAS. Diagnostic delay was longer, sacroiliitis grade 2 was more frequent, while sacroiliitis grade 3 was less frequent in southern male AAS than those in northern male AAS. Significant diagnostic delay and higher prevalence of HLA-B27 were found in southern AS patients. The prevalence of buttock pain and peripheral arthritis at disease onset in northern AS was more frequent than in southern AS patients.

NOSOLOGICAL DIAGNOSIS OF JUVENILE ARTHRITIS AT DIFFERENT FOLLOW-UP STAGES

Objective: to define the nosological category of juvenile arthritis (JA) in patients of different ages with different disease stages and follow-up periods. Subjects and methods. Group 1 included 135 children, mainly girls (60.7%), aged 1 to 16 years (range 7.9±5.0 years) with early-onset JA, the duration of which was 2 weeks to 6 months (range 2.9±1.6 months) who were further followed up for 2 years. Group 2 comprised 97 adult patients, mainly women (80.4%) aged 18 to 60 years (range 26.8±7.9 years) who had suffered from JA since childhood. The history of the disease varied from 10 to 53 years (range 20.5±8.2 years). The diagnosis in the children was made in accordance with the working criteria developed at the Pediatric Department of the Research Institute of Rheumatology, Russian Academy of Medical Sciences, for juvenile rheumatoid arthritis (JRA) and chronic JA (CJA). That in the adults was established by the diagnostic criteria for rheumatoid arthritis (RA), spondylarthritis (SA), ankylosing spondylitis (AS), and psoriatic arthritis (PA). Results. In the early-onset arthritis group, nonrheumatic diagnoses were made in 5 patients just in the first stage, which was a basis for their exclusion from the investigation. Reactive arthritis was diagnosed most frequently (46.3%) in the place of primary observation, the proportion of patients with this condition, when included into the study, was 4.4%; the diagnoses of JRA and CJA were established in 12.6 and 44.4% of cases, respectively. Later on, over 2 years of follow-up, the predominance (74.1%) of patients with CJA was retained. One patient with CJA developed obvious juvenile AS (JAS); JRA was verified in 3 children; acute rheumatic fever (ARF) and Kawasaki disease were in 2 cases; in 3 patients, rheumatic diagnoses (dysplastic coxarthrosis in 1 case, meniscopathy in 1, and leukoencephalitis in 1) were rejected. Ten years or more after disease onset, the adult patients with JA were diagnosed as having RA in 52% of cases; 11.5% had one of the types of SA; AS, PS, Crohn's disease- associated arthritis being in 4, 2, and 1 cases, respectively. Other diseases accounted for 11.5%. A diagnosis could not be verified in 25% of the patients; it was formulated as CJA or undifferentiated arthritis (UA). Among the patients with uveitis, the equal number (37.5%) RA or one of the types of SA; a diagnosis could not be specified in 25%, it was formulated as CJA (UA) or other diseases. Conclusion. This investigation has demonstrated that the diagnosis of JA presents certain difficulties and requires a thorough differentiated approach. Nosologically, the evolution of JAfollows the ways various joint diseases, such as JRA (RA), JAS (AS), other types of SA, develop; however, their diagnosis may be ultimately verified in different periods of the course of disease and a follow-up. The elaboration of current diagnostic criteria for JA, including those for JRA, will facilitate early disease recognition and timely selection of adequate and the most optimal patient management tactics

Features of Undifferentiated Spondyloarthropathy and Juvenile Spondyloarthropathy Among Asian Populations

The spondyloarthropathies (SpA) are defined as inflammatory arthropathies characterised by sacroiliac involvement and a relationship to HLA-B27. Undifferentiated spondyloarthropathy (USpA) includes the forms that do not meet the criteria for the established categories of SpA. The clinical spectrum of USpA is therefore wide, due to the various combinations of clinical and radiological manifestations of SpA. In a European population study, USpA was found to be the second most common clinical entity in the SpA group. However few studies have been published on USpA, since it has usually been overlooked due to inadequate classification criteria. Juvenile onset spondyloarthropathy (JSpA) is a term that refers to a group of HLA-B27-associated inflammatory disorders affecting children under the age of 16 years. Unlike adult SpA, there is higher prevalence of peripheral arthritis/enthesitis and lower axial symptoms. Although USpA is common, and juvenile ankylosing spondylitis (JAS) has different clinical features and a different prognosis from adult ankylosing spondylitis (AAS), few studies in Asia on these entities have been published. This paper reviews the literature on USpA and JSpA (particularly JAS) among Asian populations, and compares it to Western population studies. Keywords: Undifferentiated spondyloarthropathy, juvenile ankylosing spondylitis, HLA-B27

Neuroendocrine immune features of pediatric inflammatory rheumatic diseases.

Juvenile rheumatoid arthritis (JRA) and juvenile systemic lupus erythematosus (JSLE) are the most common autoimmune rheumatic diseases in children associated with high levels of autoantibodies and immune reactivity. JRA and JSLE are more common in girls. Disease activity is worse in the morning, improves during the daytime and worsens at night suggesting that neuroendocrine immune mechanisms are involved in disease pathophysiology. Adult patients with RA and SLE have excessive levels of prolactin (PL) while cortisol (CS) production is down-regulated for the degree of ongoing inflammation. PL has potent proinflammatory properties. Normal to low levels of cortisol have been observed in children with active JRA despite the high serum levels of IL-6, IL-1 beta, and TNF-alpha, which activate the hypothalamic-pituitary-adrenal axis (HPA). The CS levels are in fact subnormal because inflammatory stress activates the HPA. Normal serum PL levels were seen in children with JRA, most of whom were not active with higher levels in those with active ANA +ve JRA complicated by uveitis. A trend toward high PL levels was seen in 33 children with JSLE. High serum PL levels are seen in patients with active juvenile ankylosing spondylitis (JAS) only. Growth retardation is a feature of JRA. Patients with JRA have low to normal levels of growth hormone (GH) and low levels of insulin-like growth factor 1 (IGF-1). IGF-1 mediates the effects of GH. The observation of low IGF-1 in JRA raises the therapeutic possibility with IGF-1. Overall, high levels of follicle stimulating hormone and luteinizing hormone are found in children with JSLE while the levels in JRA tend to be normal. Testosterone levels are low in patients with JRA. No significant differences in estrogen levels have been found between patients with JRA and those with JSLE and matched controls. There is evidence that the autonomic nervous function is defective in patients with JRA.

Sulphasalazine in the treatment of children with chronic arthritis

The aim of this study was to investigate the efficacy and toxicity of sulphasalazine (SASP) in the treatment of children with chronic arthritis. The medical records of 36 children (25 boys, 11 girls) who received SASP for the treatment of chronic arthritis were reviewed. Twenty-one patients had juvenile spondyloarthropathies (JSA) (eight juvenile ankylosing spondylitis (JAS), 13 undifferentiated JSA (uJSA) and 15 had juvenile rheumatoid arthritis (JRA). The patients received SASP therapy for a mean of 2.5 years (range 3 weeks to 8.1 years). Clinical and laboratory data were reviewed retrospectively to determine the effects of treatment. A clinically significant response occurred in 23 (64%) children: remission in 14 (39%) (JRA 5, JSA 9) and improvement (25% reduction in joint count) in nine (25%) (JRA 4, JSA 5). There was no difference in response rate between JRA and JSA patients (p = 0.11), but the time to remission was shorter in JSA patients (mean 5 months) than in JRA patients (mean 25 months) (p = 0.024). Twelve of the 36 patients discontinued non-steroidal anti-inflammatory drugs, and six of eight patients discontinued prednisolone. A significant fall in erythrocyte sedimentation rate and rise in haemoglobin occurred in SASP-treated patients (p < 0.005) comparing most recent results with pretreatment levels. Side-effects occurred in four of 36 patients (11%); only one patient who had persisting severe diarrhoea required discontinuation of SASP. It was concluded that SASP appears to be effective and safe in the treatment of JRA and JSA patients. As a second-line agent, SASP is the drug of first choice for patients with JSA; for JRA patients SASP may be a useful, possibly less toxic alternative to methotrexate.

Shoulder, Knee, and Hip Pain as Initial Symptoms of Juvenile Ankylosing Spondylitis: A Case Report

Ankylosing spondylitis is a systemic disease typically manifested by persistent back pain or stiffness unrelieved by rest. Although not often recognized, ankylosing spondylitis can also cause peripheral joint pain, particularly in the hips, knees, ankles, and shoulders. In the pediatric form of the disease, juvenile ankylosing spondylitis, peripheral joint involvement is more frequent and can precede, by many years, the onset of back symptomatology. The following case is an example of a teenager who presented to physical therapy with a variety of common peripheral joint complaints over a 3-year period. Eventually, he was diagnosed with juvenile ankylosing spondylitis. Lack of awareness of the manifestations of ankylosing spondylitis and juvenile ankylosing spondylitis may lead to significant delay in diagnosis and initiation of appropriate therapy. A physical therapist may be the first health professional to assess a patient's lack of response to treatment for a seemingly typical diagnosis and should be aware of potential alternate diagnoses.

Juvenile Ankylosing Spondylitis and HLA B27 Homozygosity

Ten consecutive patients with juvenile ankylosing spondylitis were investigated in a prospective study. At least one of the parents of each patient had a positive history of probable or definite ankylosing spondylitis, Reiter's syndrome, or acute anterior uveitis. The patients and their parents were examined clinically and were HLA-typed. Nine of the 10 patients exhibited the genetic marker HLA B27, but only one patient was homozygous for HLA B27. This prevalence of homozygosity among HLA B27 positive persons could be expected to occur by chance alone. Based on the limited material studied, we cautiously conclude that HLA B27 homozygosity is probably not responsible for disease onset in childhood.

Spontaneous Atlantoaxial Subluxation as a Presenting Manifestation of Juvenile Ankylosing Spondylitis

Spontaneous Atlantoaxial Subluxation as a Presenting Manifestation of Juvenile Ankylosing Spondylitis