Młodzieńcze zesztywniajÄ ce zapalenie stawów kręgosłupa - problem interdyscyplinarny, opis przypadku

Juvenile ankylosing spondylitis (JAS) belongs to both a spondyloatropathy group as well as to a juvenile idiopathic arthritides group. In the latter it is classified as an enthesitis-related arthritis. In children the enthesitis is a prominent symptom at the onset of the disease, while spinal symptoms and limitations of motion may not be present until several years later. Systemic manifestations (weight loss, fever, leukocytosis, anemia) occur at disease onset in children more frequently than in adults. Initial radiography findings of the sacroiliac regions and spine are often normal or difficult to interpret in children. The aim of our study was to present this disease as one of many causes of back pain but first and foremost as the one resulting in spine mobility impairment. A 17.5-year-old boy suffered for three years from spinalgia, coxalgia, gonalgia as well as from pains in the area of sacroiliac joint and heels. After several orthopedic consultations he was finally diagnosed for a right thoracic curve (I°) and “spinal stiffness”. After 9 months rheumatologists identified JAS (sacroilitis bilateralis - II-III°) and administered non-steroid anti-inflammatory treatment followed by sulphazalasin. For the next 8 months he underwent neither rheumatological and orthopedic treatment nor was he rehabilitated. Due to high inflammation parameters and significant limitations in the mobility of the spine as well of the hip and shoulder joints accompanied by impaired respiratory capacity of the chest the pediatric rheumatologist successfully included matotrexat and intensive rehabilitation into therapy. It is necessary to increase our knowledge concerning the onset of the juvenile ankylosing spondylitis which is a common rheumatic disease leading to disability and invalidism.