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Comparison of clinical and radiographic severity of juvenile-onset versus adult-onset ankylosing spondylitis
  1. Finbar D O'Shea (boshea{at}
  1. Toronto Western Hospital, Canada
    1. Eleanor Boyle (eboyle{at}
    1. Toronto Western Research Institute, Canada
      1. Reena Riarh (rriarh{at}
      1. Toronto Western Hospital, Canada
        1. Shirley M Tse (shirley.tse{at}
        1. Hospital for Sick Children, Canada
          1. Ronald M Laxer (ronald.laxer{at}
          1. Hospital for Sick Children, Canada
            1. Robert D Inman (robert.inman{at}
            1. Toronto Western Hospital, Canada


              Objectives: An important unresolved issue in pathogenesis and clinical course of ankylosing spondylitis (AS) has been whether juvenile-onset AS (JoAS) is a clinical entity in its own right, or just an earlier onset variant of its adult-onset AS (AoAS) counterpart. In this study, we address this issue.

              Methods: All AS patients were extracted from the database of a large Spondylitis Clinic. Those with symptom onset of ≤ 16 years were compared to those with symptom onset ≥ 17 years. Odds ratios (OR) were calculated and adjusted for disease duration and current age.

              Results: 267 AS patients were identified. 84 met criteria for JoAS and 183 met criteria for AoAS. There were no differences in gender ratio (Males: JoAS 81%; AoAS: 79%), nor 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% JoAS but in only 4.6% AoAS (p<0.0001). There were no differences in disease activity between the two groups. Adjusted for disease duration, axial features were more prominent in AoAS than JoAS as represented by neck pain [OR 2.93 (1.54,5.55)], neck stiffness [OR 3.39 (1.80,6.39)], back pain [OR 2.96 (1.43,6.11)], back stiffness [OR 3.30 (1.50,7.28)]. Adjusted for disease duration, AoAS was associated with worse functional and quality of life measures, and higher fatigue scores.

              Conclusions: JoAS follows a distinctive clinical course from its AoAS counterpart. Furthermore, these clinical features are dictated by factors other than male gender and HLA-B27 and warrant further investigation.

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