DOI: https://doi.org/10.22141/2224-0713.8.102.2018.153540

Nervous system disturbances in juvenile- and adult-onset ankylosing spondylitis

O.E. Chernyshova, O.V. Syniachenko, T.R. Polesova, M.V. Yermolaeva

Abstract


Background. The prevalence of ankylosing spondylitis (AS) among the population reaches 0.3 %, it is much more likely to develop at the age of 20–30 years. There are two forms of AS: juvenile (JAS) and adult, depending on the age of the disease onset. The diagnosis of JAS is one of the most urgent problems in pediatric rheumatology, while the evolution of this disease in adulthood remains unexplored. There is an age-related dimorphism of the central nervous system (CNS) and peripheral nervous system (PNS) disturbances, but among patients with JAS and in other cases, it has not been investigated. The purpose of the research was to examine patients with AS in terms of the incidence and nature of the course of CNS and PNS disturbances and to evaluate their characteristics in juvenile- and adult-onset of this disease. Materials and methods. Two hundred seventeen patients with AS (193 men and 24 women), with an average age of 38 years, were exami-ned. The rapidly progressing course was detected in 21 % of cases, moderate and high degree of activity — in 79 %, stage ІІ–ІІІ — in 82 %, and polyarthritis — in 65 %. JAS was diagnosed in 16 % of patients (all boys), among them, stage III occurred twice as often as among other patients. Results. Changes in PNS are observed 4.9 times more often in patients with JAS, and in CNS — 2 times less often than in cases of adult-onset. Moreover, among patients of group 1, the severity of CNS disturbances is associated with involvement of the cervical spine and the prevalence of spondylopathy, and of PNS — with presence of tendovaginitis, arthritis of the shoulder and hip joints, and changes in the thoracic spine, while in the group 2 it is associated with the parameters of the integral index of arthritis activity and the X-ray stage of the disease, with disorders of shoulder, hip and sacroiliac joints, wherein the age of the disease onset affects the development of asthenovegetative and corticonuclear syndrome, the emergence of radiculopathy, cervicocranialgia and carpal tunnel syndrome, and in the pathogenetic architectonics of CNS pathology, the level of immunoglobulin-A plays a greater role, of PNS — the serum interleukin 1-b contents, which, in addition, determine the occurrence of cervicocranialgia in cases of JAC, and in the remaining observations of AS — the Morton’s metatarsalgia. Conclusions. AS with different age of the disease onset is a risk factor for the development of certain symptoms of CNS and PNS disturbances, which in these groups have their pathogenetic features.

Keywords


ankylosing spondylitis; children; adults; nervous system; disturbances; course

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