Objectives We aimed to assess differences between juvenile-onset ankylosing spondylitis (JOAS) and adult-onset ankylosing spondylitis (AOAS) in terms of activity, severity and quality of life (QoL) in Moroccan patients.
Methods In this cross-sectional study, 120 patients with ankylosing spondylitis according to the modified New York classification criteria were consecutively recruited. JOAS was defined as an age at onset ≤16 years-old and AOAS >16 years-old. Assessment criteria included: sociodemographic data, educational level, diagnosis delay, peripheral and axial pain (on a visual analogue scale), disease activity (Bath Ankylosing Spondylitis Disease Activity index), functional impairment (Bath Ankylosing Spondylitis Functional Index), spinal mobility (Bath Ankylosing Spondylitis Metrology Index); structural damage (Bath Ankylosing Spondylitis Radiologic Index) and treatment details. The Maastricht Ankylosing Spondylitis Enthesis Score (MASES) was applied to assess severity of enthesitis. Laboratory tests included the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP). The generic instrument SF-36 was used to assess QoL. Comparisons were examined using a T test for continuous variables and Chi-square test for categorical variables. Logistic regression models were used to assess associations between JOAS and disease parameters.
Results In our data, 37 patients (30.8%) had JOAS and 83 (69.1%) had AOAS. There were no differences between the two groups according to gender, socioeconomic status, diagnosis delay, treatments, structural damage (BASRI) or scores of spinal mobility. However, patients with JOAS had more severe peripheral pain intensity, higher clinical and biological disease activity (BASDAI and CRP), severe enthesitis scores; impaired functional ability and more prevalent hip involvement (for all p≤0.001). Moreover, patients with JOAS had lower educational level (p=0.014) and significantly lower scores of physical domains of QoL (for all p≤0.01). In logistic regression, JOAS was associated with severe peripheral pain [OR =1.391-CI (95%) 0.514-0.983], higher enthesitis scores [OR =1.522-CI (95%) 1.074-1.864] and severe functional disability [OR =1.517-CI (95%) 1.108-1.754].
Conclusions In our study, we state that our AS patients presented differently according to the age at onset. Patients with JOAS had altered aspects of QoL with more peripheral and entheseal involvement, high disease activity an altered functional ability. An early diagnosis and treatment of AS, particularly JOAS seem to be important in order to improve patients’ living and quality of life.
Disclosure of Interest None Declared