A case of childhood-onset ankylosing spondylitis: diagnosis and treatment.
BACKGROUND
A 14-year-old boy with a 6-year history of recurrent arthritis and enthesitis, which had not responded to previous treatment with NSAIDs, sulfasalazine and methotrexate, presented with a severe flare of these symptoms as well as spinal and sacroiliac joint pain. The patient's father had mild psoriasis.


METHODS
Counts of tender and swollen joints and tender entheses; assessment of spinal mobility; assessments using the Childhood Health Assessment Questionnaire and the Bath Ankylosing Spondylitis Disease Activity and Functional Indices; measurement of erythrocyte sedimentation rate, serum C-reactive protein level and human leukocyte antigen B27 positivity; radiographs of the sacroiliac joints, hips and feet.


METHODS
Juvenile-onset ankylosing spondylitis according to the modified New York criteria for ankylosing spondylitis, on the basis of the presence of inflammatory back pain, reduced mobility of the spine and grade 3 bilateral radiographic sacroiliitis.


RESULTS
Treatment with NSAIDs, sulfasalazine and methotrexate did not improve the patient's symptoms. Administration of infliximab 5 mg/kg induced a substantial and rapid improvement in all parameters of disease activity.
Burgos-Vargas
Rubén
R
Rheumatology Department, Hospital General de México, Universidad Nacional Autónoma de México, Mexico City, Mexico. burgosv@prodigy.net.mx
D000293:Adolescent; D017668:Age of Onset; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D006304:Health Status; D006801:Humans; D000069285:Infliximab; D007596:Joints / Q000503:physiopathology; D008297:Male; D011859:Radiography; D012074:Remission Induction; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab