[Ankylosing spondylitis in children and adolescents].

Ankylosing spondylitis is a disease that usually affects young men, though older men and both young and middle-aged women may suffer from the condition. Close questioning of patients will often elicit a previous history of fleeting joint pains, 'growing pains' and pains low in the back and down the thighs-such symptoms may have been of several years' duration. To Scott (1942) is due the credit for this observation. He recorded cases whose symptoms could be traced back to childhood and he named this stage of the illness 'the prespondylitic syndrome'. He further stated that on account of the wandering nature of the pains, most of such patients have been erroneously treated for months or years for such conditions as recurrent fibrositis, muscular rheumatism or even just growing pains. More recently other authors have confirmed Scott's (1942) observations. Hart (1955) reported that 18 out of 166 male and two out of 18 female patients suffering from established ankylosing spondylitis complained of symptoms beginning between the ages of 10 and 15 years. Edstrom, Thune and Wittbom-Cigen (1960) recorded three boys in whom ankylosing spondylitis started at the ages of 5, 8 and 12 years. Ansell and Bywaters (1962) followed up 43 children who were regarded initially as probably but not definitely suffering from Still's disease. Two of these children developed ankylosing spondylitis, their ages at the onset of symptoms were 10 and 12 years; their sex was not recorded. Though it is true that the possibility of such an early onset of ankylosing spondylitis is becoming increasingly recognized, it is felt that this is not widely known. Due to the indefinite symptomatology and particular age incidence, these patients may seek help from a wide variety of practitioners such as general physicians, paediatricians, rheumatologists and orthopaedic surgeons. Others may remain for years under the care of their general practitioners. In this paper, three cases are presented whose initial symptoms dated from the ages of 10, 11 and 15 years, and over the years the development of the classical picture of ankylosing spondylitis was observed. Problems of the diagnosis are discussed with special reference to radiological findings.