Enthesopathies in childhood-onset and adult-onset ankylosing spondylitis
Background. The prevalence of ankylosing spondylitis (AS) among the population reaches 0.3 %, which is much more likely to develop at the age of 20–30 years. Two forms of AS are distinguished: pediatric and adult, depending on the age of the disease debut. The diagnosis of juvenile AS (JAS) is one of the most urgent problems in pediatric rheumatology, while the evolution of this disease in adulthood remains unexplored. JAS is considered as “enthesitis-related arthritis”, which is observed among 10–20 % of the total number of patients. The purpose was to study patients with AS regarding the incidence and nature of the course of enthesopathy and to evaluate its characteristics in childhood- and adult-onset of the disease. Materials and methods. 217 patients with AS (193 men and 24 women) with an average age of 38 years were examined. The fast-progressing course of the disease was detected in 21 % of cases, moderate and high degree of activity — in 79 % of cases, the ІІ–ІІІ stage — in 82 %, and polyarthritis — in 65 %. JAS was detected in 16 % of cases (all boys), among them the third stage occurred twice as often as among the other patients. Results. Enthesopathies are observed in 39 % of the total number of patients with AS, 3.1 times more often in case of JAS, which is characterized by tarsitis, disturbances of the quadriceps tendons, condyles of the femur, sites of insertion to the vertebrae and ribs, and for the disease with an onset in adulthood, the involvement of the Achilles tendons is atypical, moreover, the prognosis-negative signs regarding enthesitis and tendovaginitis are the prevalence of peripheral articular syndrome, the parameters of the integral index of arthritis activity and the Lansbury index, arthritis of the ankle, hip and facet joints, the presence of bone erosion and arthrocalcinates, and in pathogenetic architectonics of enthesopathies the immune disorders are involved, while the distinct manifestation of syndesmophytes and spondyloarthrosis in the vertebrae is common for AS with different age debut of the disease, and in cases of adult-onset disease, in addition, the availability of epiphyseal osteoporosis and bone erosion. Conclusions. JAS is a risk factor for the development of enthesopathies, which have their clinical and pathogenetic features of the course among patients with the different age of the disease debut.
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