Juvenile Ankylosing Spondylitis
Introduction
Introduction to juvenile joint stiffness and spondylitis Juvenile ankylosing spondylitis (JAS) refers to a connective tissue disease characterized by chronic inflammation of the joints such as the ankle and the spine. basic knowledge The proportion of illness: 0.001% Susceptible people: before 16 years old Mode of infection: non-infectious Complications: iridocyclitis Aortic regurgitation
Cause
The cause of juvenile joint stiffness and spondylitis
(1) Causes of the disease
The etiology of this disease is still unclear. It is currently believed that due to genetic predisposition factors, the disease is triggered by certain environmental factors. It is generally believed that the incidence of this disease is significantly correlated with HLA-B27. The positive rate of foreign reports is 90. %, Beijing Children's Hospital reported that 29 of 33 cases were positive, suggesting that the pathogenesis of this disease is related to heredity. In terms of environmental factors, recent studies have suggested that it is related to certain bacteria or other microbial infections, such as certain Klein strains may have Trigger the role of this disease.
(two) pathogenesis
JAS has obvious genetic characteristics, and it is often found that several people in the same family are sick. The detection rate of HLA-B27 is very high (90% to 94%), but in addition to JAS, Rut's disease, psoriatic arthritis, Inflammatory bowel disease, reactive arthritis, and seronegative tendin syndrome are highly associated with HLA-B27. The positive rate of HLA-B27 in the general population is only 6% to 8% (Khan and Linden et al., 1990), presumably JAS and HLA-B27 is highly correlated, and individuals with this genetic background are prone to abnormal reactions to certain environmental factors, and infection may be an important key environmental factor. JAS, Rut's disease, and reactive arthritis are closely related to each other. There may be a common infection factor playing a key role in the pathogenesis. Some people think that Klebsiella, Shigella and HLA-B27 antigen have similar molecular structure, which may be an important cause of AS.
Prevention
Juvenile joint tough spine prevention
The etiology of this disease is unclear, and it is related to the abnormal immune response induced by infection. It should actively prevent and treat various infectious diseases, pay attention to nutrition, enhance physical fitness and do vaccination work.
Complication
Complications of juvenile joint stiffness and spondylitis Complications, iridocyclitis, aortic regurgitation
Rib joint disease can be limited, which can limit the expansion of the chest; acute iridocyclitis can occur; aortic inflammation or aortic dilatation may occur after a long-term attack, and aortic regurgitation is reported occasionally in JAS.
Symptom
Juvenile joints, severe vertebral inflammation, common symptoms, spinal stiff joints, strong back, persistent pain, ankle pain
JAS is often caused by repeated pain in the lower back, buttocks, groin, hips, etc. These early symptoms may be misdiagnosed for a long time, until more special symptoms appear, and if the child has a lower limb joint Disease, performance similar to oligoarthritis type II JRA, should pay more attention to the diagnosis of early cases of JAS, ankle arthritis is a key condition for the definite diagnosis of JAS, JAS early may be found due to lumbosacral joint disease caused by lumbar anterior protrusion disappear, limit The lower anterior curvature of the spine (Schober sign positive), if the rib joint disease will reduce the degree of chest dilatation, about half of the JAS cases can not meet the diagnostic criteria in the early stage, and nearly half of the patients have only one episode, about 18% The patients have a long process of disease, most people can retain the intact joint function, Beijing Children's Hospital observed that 10 cases of girls JAS 40% of the lumbosacral joint disease, 60% of peripheral joint disease, early diagnosis is conducive to treatment and Prognosis, found that spinal lesions are the core of early diagnosis.
5% to 10% of children with JAS develop acute iridocyclitis, Beijing Children's Hospital observed 10 cases of girls with JAS and iridocyclitis accounted for 30%, adult AS patients may have aortic inflammation or aortic dilatation after prolonged attack The incidence of JAS aortic lesions is lower than in adults, and occasionally there is a report of aortic regurgitation in JAS.
Examine
Examination of juvenile joint spondylitis
There is no special examination item in JAS. There may be mild anemia during activity, erythrocyte sedimentation rate, negative RF and ANA, and HLA-B27 positive rate can also be as high as 90%. It is also reported that the positive rate of HLA in JAS patients is lower than that in adult AS. Most people think that HLA-B27 positivity is still an important clue for early differential diagnosis of juvenile rheumatoid joints and JAS.
Radiological examination is very important for the detection of ankle arthritis, but unfortunately, in the early stage, even within a few years, there is no basis for ankle joint disease. Radiographic changes are characterized by ankle joint surface sclerosis, erosion or joint space widening, and then Development of joint space narrowing and stiffness, CT and MRI scans will find ankle arthritis earlier than ordinary X-ray films, MRI can detect chronic inflammation more sensitively, and ligament callus formation can be found in the late stage of AS. The articular processes merge to form a "bamboo-like" spine.
1. Bilateral hip arthritis 2 to 4 grades.
2. Unilateral hip arthritis 3 to 4 grades.
Diagnosis
Diagnosis and identification of juvenile articular spondylosis
diagnosis
According to foreign data, the diagnosis of juvenile joint spondylitis is based on X-ray confirmed unilateral or bilateral ankle arthritis, and at least 2 to 3 of the following conditions are attached respectively (foreign diagnostic criteria in New York) "):
1. Schober sign positive: the anterior curvature of the spine is limited (Schober sign positive) or extension, and the lateral direction of the lateral bend is limited.
2. Have a history of low back pain or past history: lower back pain lasted for more than 3 months, rest can not be relieved, and after the activity is reduced.
3. Chest expansion is limited: the chest circumference is measured in the fourth intercostal space, and the chest circumference is increased by 2.5 cm when inhaling.
4. Arthritis: peripheral arthritis, especially lower extremity arthritis; inflammation of the heel pain or tendon attachment point.
5. HLA-B27 is positive.
6. Family history of spondyloarthropathy.
Differential diagnosis
The disease should be differentiated from spinal cord tumors, lumbar vertebrae infections, disc disease and Scheuermanns Disease.
It should also be differentiated from Legg-Calvé-Perthes Disease and congenital hip and thigh pain.
Ulcerative colitis, limited intestinal inflammation, psoriasis and Reiter syndrome may be associated with spondylitis, and its performance is similar to ankylosing spondylitis, but in addition to spondylitis, the above diseases have their own clinical features and can be identified. .
