Ankylosing Spondylitis: Severity and Progression in Young Adults

Q: Ankylosing Spondylitis: Severity and Progression in Young Adults

Hello, thank you for your question. <br>Here are my responses：<br>1. <br>Will the stiffness of the spine and cervical spine in patients with juvenile ankylosing spondylitis be more severe compared to adults who develop the condition later? (Since the duration of the disease is lo

Ankylosing Spondylitis

Hello Doctor: 1.
Will the degree of spinal and cervical stiffness in patients with juvenile ankylosing spondylitis be more severe compared to those who develop the condition in adulthood? (Since the onset occurs earlier.) 2.
Will every patient experience spinal stiffness or kyphosis before the age of 40? If not guaranteed, what is the approximate probability? Is it more than half? Thank you!

Nora, 10~19 year old female. Ask Date: 2023/10/23

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1.
Will the stiffness of the spine and cervical spine in patients with juvenile ankylosing spondylitis be more severe compared to adults who develop the condition later? (Since the duration of the disease is longer.) --> The longer the duration of the disease, the higher the likelihood of spinal stiffness in the future.
However, if the disease is well-controlled and the patient engages in regular exercise, many individuals with juvenile ankylosing spondylitis may not show any signs of the condition.
Factors influencing future spinal stiffness include inflammatory markers, age of onset, number of affected joints at the time of diagnosis, and the specific joints involved, among others.
Therefore, it is not possible to make a blanket statement.
2.
Will every patient experience stiffness or kyphosis in their spine before the age of 40? If not, what is the approximate probability? Is it more than half? --> Currently, there are no statistics available on this.
The prognostic factors affecting spinal stiffness have been mentioned above.
If a patient does not have these prognostic factors, their condition can usually be well-managed, so there is no need to overly worry about the likelihood of future spinal deformity.
It is important to adhere to the physician's treatment plan and engage in regular exercise, as many complications related to the spine can be prevented.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2023/10/23

More Info

Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. It is classified as a type of axial spondyloarthritis and often begins in young adulthood or even in adolescence. Your questions regarding the severity and progression of AS in young adults are very pertinent, especially considering the long-term implications of this condition.

1. Severity of Spinal and Cervical Stiffness in Young Adults with Early-Onset AS: Generally, individuals diagnosed with juvenile or early-onset ankylosing spondylitis tend to experience more severe disease progression compared to those who develop the condition later in life. This is largely due to the prolonged duration of inflammation and the cumulative effects of the disease on the spine and surrounding structures. Early-onset AS can lead to more significant structural changes, such as syndesmophyte formation (bony growths in the spine) and eventual fusion of the vertebrae, which can result in a more rigid spine. Studies have shown that patients with early-onset AS often have a higher risk of developing severe spinal deformities, such as kyphosis (forward bending of the spine), due to the chronic nature of inflammation and the resultant damage to the spinal architecture.

2. Likelihood of Stiffness or Kyphosis Before Age 40: The progression of ankylosing spondylitis varies significantly among individuals. While many patients may experience stiffness and reduced spinal mobility, not every patient will develop severe kyphosis or significant spinal deformity by the age of 40. Research indicates that approximately 30-50% of patients with AS may develop some degree of spinal fusion or kyphosis over time, but this is not a universal outcome. Factors influencing the severity of disease progression include genetic predisposition (such as the presence of the HLA-B27 antigen), the age of onset, the effectiveness of treatment, and individual responses to therapy.
In summary, while early-onset AS can lead to more severe outcomes, the degree of stiffness and the likelihood of developing kyphosis by age 40 can vary widely among individuals. Regular monitoring and proactive management of the disease are crucial. Treatment options, including nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and biologic agents, can help manage symptoms and potentially slow disease progression.
It is essential for patients with AS to maintain an active lifestyle, engage in regular exercise, and follow a tailored treatment plan developed in consultation with healthcare providers. Early intervention and adherence to treatment can significantly improve quality of life and functional outcomes for individuals with ankylosing spondylitis.

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