Many adults with AS say they first remember experiencing symptoms back in childhood.

When symptoms do first develop in childhood, the condition falls into a group of conditions known as juvenile spondyloarthropathies (SpA).

There are a number of similarities between juvenile and adult SpA but also a number of important differences.

What are juvenile SpA?

Juvenile SpA are a group of chronic inflammatory diseases of the joints (arthritis) and tendon insertion points (enthesitis) which occur before the age of 16.

Symptoms often first start in the large joints of the leg or in the tendon insertion points such as the sole of the foot, achilles tendon, base of the kneecap or the groin. The sacroiliac (SI) joints can also be affected first in juvenile SpA.

How common are juvenile SpA?

SpA are one of the forms of juvenile arthritis. Juvenile idiopathic arthritis (the umbrella term for all types of juvenile arthritis) is seen in about 1 in 1000 children. Of these, up to 30% may be classed as having enthesis related arthritis (ERA).

The cause of juvenile SpA

Like most rheumatological diseases, the precise mechanisms that cause juvenile SpA are still being investigated. These conditions are thought to be multifactorial. This means they might be a result of exposure to environmental factors, such as an infection, in children with a genetic predisposition to the condition.

Outlook for the future

There are no up to date studies that indicate how many children with a juvenile SpA will go on to develop adult AS.

The disease course can be very different from one child to another. In some cases the condition disappears very quickly after only a few months of treatment. In other cases the arthritis may come and go over time and in some cases the condition remains constant.

Children with arthritis of the sacroiliac joints, the spine or hip joints and those with persistent arthritis are known to be more likely to go on to have joint problems in adult life.

It's very important to remember that dramatic improvements in treatments for these conditions are helping prevent joint damage for the majority.

Management

As with adult AS, treatment includes a combination of medication and physiotherapy.

Medication

The medications used may vary depending on the severity of the condition.

Non-steroidal anti inflammatories (NSAIDs) can be useful in helping to reduce the symptoms of inflammation. They can help the pain, stiffness, heat and, to some extent, the swelling. The most common NSAID used in children is ibuprofen or naproxen. Click here for more information on NSAIDs.

Steroid joint injections can be very useful when only a small number of joints are affected. These can be done under general anaesthetic if needed or using gas and air (entenox). Click here for more information on steroid injections.

If symptoms are not controlled with NSAIDs or steroid injections a disease modifying anti rheumatic drug (DMARD) might be used or the rheumatologist might think anti TNF therapy is most suitable.

Physiotherapy

It is very important for children with SpA to have physiotherapy. Click here for more general information on the benefits of physiotherapy in AS and ways to access physiotherapy.

Juvenile SpA physiotherapy:

  • Helps with self management
  • Shows pain management techniques
  • Gives an exercise programme specifically tailored to the child's needs

The exercise programmes will aim to maintain and improve the range of movement in joints and prevent future problems.

It's very important that attention is paid to the length of the muscles. Children and teenagers are very prone to getting tight muscles. During a growth spurt the bones grow first and the muscles then stretch to catch up. Tight muscles can lead to mechanical joint pains. Children with juvenile SpA need to be extra careful about this because tight hamstring muscles at the back of the thighs pull on the pelvis flattening the lower back. This is the first movement that is lost when the spine begins to curve over (kyphosis).

Education

Teenagers in particular will only continue with exercise if they understand why they need to do it. Educating children and teenagers about their condition is very important. The emphasis should be on maintaining active participation and function through all aspects of their life.

Last reviewed: November 2010