Juvenile ankylosing spondylitis (JAS) is a form of inflammatory arthritis that develops in children and young adults. It mostly affects the spine but can also affect the enthesis, where the tendons and ligaments meet the bone.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
JAS can also affect other organs and areas of the body.
According to the Arthritis Foundation (AF), JAS occurs more commonly in males and has a genetic component. If someone in the immediate family has JAS, a child is more likely to develop the condition.
In this article, we will examine the causes, symptoms, risk factors, diagnosis, treatments, and outlook for a person with JAS.
JAS is an inflammatory condition that primarily affects the spine, but it can also cause pain in the hips, knees, or heels when it starts.
“Juvenile” refers to a young person. “Spondyl” is another term for vertebra, and “ankylosing” means stiff.
According to an article in The Journal of Rheumatology, ankylosing spondylitis has two forms of onset: juvenile-onset and adult-onset.
Healthcare professionals diagnose juvenile-onset ankylosing spondylitis if people experience symptoms before they reach 16 years of age.
JAS causes inflammation in the joints and entheses. This can produce pain in the hips, knees, heels, back, or buttocks.
As it progresses, bones in the spine may fuse, causing stiffness. Bones in the rib cage may also fuse, which can make breathing difficult.
JAS can affect the eyes, too. Chronic eye inflammation, or uveitis, can lead to pain, redness, dryness, difficulty seeing, and light sensitivity.
Chronic inflammation in the gastrointestinal tract can also lead to inflammatory bowel disease, resulting in diarrhea and abdominal pain.
If nerves in the back become pinched, weakness or numbness can develop in the legs, or pain may develop in the buttocks and thighs.
Learn more about the effects of ankylosing spondylitis and how to treat them here.
A 2013 review notes that symptoms typically begin when a person reaches their 20s. However, 18% percent of cases develop earlier. Doctors refer to these as juvenile-onset.
Symptoms generally develop slowly over several weeks or a month. They vary widely but start with pain in the hips, knees, or heels. Pain in the lower back and buttocks may develop next.
The Children’s Hospital of Philadelphia notes that the most common symptoms of JAS include:
- stiffness upon waking or after inactivity
- pain in the buttocks or back that improves with activity
- pain in the knees, heels, or the bottom of the feet that worsens with activity
- abdominal symptoms, such as weight loss, diarrhea, and pain
- eye pain, redness, and light sensitivity
- swelling and warmth in the joints of the lower extremities
- difficulty standing or bending to touch the toes
Other symptoms include:
- back pain that occurs in the morning or during the night
- shortness of breath
- fatigue
- mild fever
- loss of appetite
- pain, swelling, and warmth in the following parts of the body:
- toes
- ankles
- heels
- knees
- buttocks
- upper spine
- rib cage
- neck
- shoulders
Symptoms of JAS may be similar to those of many other health conditions. It is important to consult with a pediatric specialist for proper diagnosis.
Healthcare professionals do not know the exact cause of JAS. However, the condition is closely
Approximately 80–90% of children and young people with JAS have the HLA-B27 gene.
It is possible that in children with the gene, JAS develops when exposed to a virus, bacteria, or other environmental condition.
However, not everyone with this gene will develop JAS.
Males are two to three times more likely to develop JAS than females.
The University of Rochester Medical Center notes there is a higher risk of developing JAS if a family member has ankylosing spondylitis.
A child or young person also has a higher risk if they carry the HLA-B27 gene marker.
A medical professional will ask for a detailed medical history, including information about family members. It is important to let them know if there is any family history of ankylosing spondylitis.
To conduct a physical examination, the medical professional may ask the child to move in certain ways to check the flexibility of their spine. They may also perform noninvasive tests to check the child’s nervous system.
The doctor or medical professional may then order further tests or scans to evaluate the possibility of JAS. These could include:
- an X-ray of the spine or pelvis
- an MRI of the spine or pelvis
- an ultrasound
- blood tests
Blood tests may look for an antigen that indicates the presence of the HLA-B27 gene marker. This gene has been linked to an increased risk of developing JAS.
Medically guided care for JAS may include medication, physical therapy, exercise, or surgery.
Medications
Several types of medications are available to treat JAS. These include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): This might include non-prescription or prescription strength medication.
- Disease-modifying antirheumatic drugs (DMARDs): Drugs such as sulfasalazine and methotrexate help prevent the immune system from causing inflammation in the joints.
- Biologics: These are a type of DMARD that interrupt the inflammatory process and help prevent disease flares.
- Corticosteroids: Examples include prednisone. These are fast-acting anti-inflammatories. However, a healthcare professional may only recommend these for limited use in children due to potential side effects.
Physical or occupational therapy
Physical therapy exercises can help strengthen the body and preserve flexibility in the spine.
An occupational therapist may provide assistive devices as well as skills training that make everyday functions simpler.
Exercise
A doctor may prescribe low-impact exercise as a key part of treatment for JAS to preserve flexibility and build strength.
Walking, yoga, biking, and swimming are often options. Stretching is also a way to preserve joint flexibility and function.
Surgery
Surgery is uncommon for JAS, but occasionally, joint replacement or spinal surgery helps to alleviate pain.
There is no cure for JAS. However, a person can treat the symptoms. Some people may choose to try alternative or natural treatments alongside medical treatments.
Some of these options include:
Acupuncture
This traditional therapy focuses on placing very fine needles into treatment points in the skin. The needles may help to release the body’s natural pain-relieving hormones.
Alexander technique
This system of movement teaches a person how to improve their posture to increase functionality. It helps a person become more aware of their body and how they move, sit, and stand.
The goal is to focus on the relationship between the head, neck, and spine and how they work to keep the body functioning well.
Massage therapy
Massage therapy should start gently, as for some people, it can cause their condition to flare up.
For others, however, it can provide relaxation and pain relief. It may even improve circulation and reduce stiffness in some areas.
TENS unit
TENS stands for transcutaneous electrical nerve stimulation. It is a control unit that is attached to the skin using wires and adhesive electrodes.
The control unit delivers short pulses of electrical current to the body in varying strengths, frequencies, and duration.
According to the National Axial Spondyloarthritis Society, the electrical stimulation from a TENS unit may impact how the brain receives pain signals. It may also prompt the brain to release pain-relieving endorphins.
Setting up a system of self-care at home is important when managing any chronic condition. To treat the symptoms of JAS, self-care should focus on:
Diet
Because JAS is an inflammatory condition, a diet rich in anti-inflammatory foods can be beneficial.
Fruits, vegetables, whole grains, fatty fish, and other elements of the Mediterranean diet are good choices, alongside limiting sugars and fats.
Posture
Maintaining good posture can help alleviate pain and lessen stiffness.
When working at a desk, a person can stand up and move around once an hour for several minutes. They can adjust the chair so that the computer monitor is at eye level. They can also hold cellphones up so that the neck is upright while reading the screen.
Support
Living with a chronic condition can feel isolating. Friends and family can provide support through listening and offering physical assistance.
For teenagers, the AF provides the iPeer2Peer program, which pairs young adult mentors with arthritis and teenagers with JAS. Some may also benefit from speaking with a licensed therapist.
JAS is a progressive disease, and several possible complications can develop, including:
- joint damage
- fusion of the spine or rib cage
- kyphosis, which is the forward curvature of the spine
- trouble breathing due to bone fusion of the rib cage
- fractures
- heart, eye, and kidney problems
Early diagnosis and continued care with a medical professional will help address complications as they arise.
The outlook for JAS varies from person to person.
Some people will have chronic symptoms, some will have intermittent flares of symptoms, and some will go for long periods when the disease is in a mild or inactive state.
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A few things that can help someone manage symptoms are:
- staying active
- resting well
- eating a healthy, balanced diet
Smoking can increase the chance of complications. Those with JAS should not smoke or should try to quit if they have started smoking.
If a child has back pain, joint pain, or morning stiffness, a caregiver should consult with a medical professional.
For a child with a JAS diagnosis, a caregiver should contact a doctor if the child experiences:
- eye symptoms
- trouble breathing
- new or worsening symptoms
JAS is a chronic inflammatory arthritis condition that causes pain in the spine and the connections between tissues and bone. It can cause bones in the spine and the rib cage to fuse, leading to stiffness and problems taking deep breaths.
Symptoms can include pain and stiffness in the back, buttocks, heels, knees, or other joints. It can also affect the eyes and gastrointestinal system.
Treatment for JAS includes medication, physical therapy, exercise, and very rarely, surgery. The goal is to maintain flexibility and mobility.
Some people with JAS may experience symptoms continually, while others may experience them from time to time, or rarely, if at all.