DISTURBANCE OF THE MUSCOLOSKELETAL SYSTEM IN JUVENILE ANKYLOSING SPONDYLITIS AND DISEASE DEVELOPED IN THE ADULTHOOD (INVOLVEMENT OF SPINE AND SACROILIAC JOINTS)

Disturbance of the muscoloskeletal system in juvenile ankylosing spondylitis and disease developed in the adulthood (involvement of spine and sacroiliac joints). Yehudina Ye.D., Syniachenko O.V., Polesova T.R., Chernyshova O.E., Yermolaeva M.V. Background. Two forms of ankylosing spondylitis (AS) are distinguished: juvenile and adult, depending on debut age of the disease. The diagnosis of juvenile AS (JAS) is one of the most urgent problems in a pediatric rheumatology. The peculiarities of AS course that onsets in childhood and adulthood are manifested by differences in the nature of a spinal column disturbance. At the same time, the evolution of JAS in adulthood remains unexplored. The goals and objectives of research: to study clinical and X-ray symptoms of spondylopathy and sacroiliitis course, to assess their characteristics in the disease that onset in childhood and adulthood. Material and methods. 217 patients with AS (193 men and 24 women) with an average age of 38 years were examined. The fast-progressing course of the disease was detected in 21% of cases, moderate and high degree of activity – in 79% of cases, the ІІ-ІІІ stage in 82%, and polyarthritis – in 65%. JAS was detected in 16% of cases (all boys), among them the third stage occurred twice more likely than among the other patients. Results. The clinical and radiologic signs of spondylopathy and sacroiliitis are observed in 95% and 97% of the total number of AS cases, respectively, among all patients with JAS lumbago was detected 4,3 times more frequently, sciatic muscles hypotrophy – 7,8 times, "the string symptom" 2,9 times", the calcification of the spinal cord 2,3 times, whereas the prevalence of spinal column injury, the severity of cervico-spondylopathy and sacroiliitis among patients with the disease debut in the adulthood is significantly greater, and the involvement in the process of the lumbar and thoracic spine are detected correspondingly twice as often and by 19%, occurrence of dorsalgia is 4 times as often, the limitation of body lateral bendover by 59%, while there are ambiguous dispersion-correlation links with extraarticular (systemic) manifestations of the disease, and the high prevalence of a peripheral articular syndrome regarding spondylopathy in JAS is a negative prognosis sign, and for the remaining patients there are indices of the Lansbury index and the index of arthropathy progression. Conclusion: the onset of AS in adulthood is a risk factor for the severe course of spondylopathy. Реферат. Поражение опорно-двигательного аппарата при ювенильном анкилозирующем спондилите и заболевании, начавшемся во взрослом возрасте (вовлечение позвоночника и крестцово-подвздошных сочленений). Егудина Е.Д., Синяченко О.В., Полесова Т.Р., Чернышева О.Е., Ермолаева М.В. Актуальность проблемы. Выделяют две формы анкилозирующего спондилита (АС) – детскую и взрослую, в зависимости от возраста дебюта заболевания. Проблема диагностики ювенильного АС (ЮАС) относится к наиболее актуальным в педиатрической ревматологии. Особенности течения АС, начавшегося в детском и взрослом возрасте, проявляются различиями в характере поражения позвоночного столба. При этом эволюция ЮАС во взрослом возрасте остается неизученной. Цель и задачи исследования: изучить у больных АС клиникорентгенологические признаки течения спондилопатии и сакроилеита, оценить их особенности при

Background. The prevalence of ankylosing spondylitis (AS) reaches 0.3% among the population [12,16]. The modern concept divides this disease by the predominantly lesion of either the peripheral joints or the axial skeleton [3,13,14]. Meanwhile, two forms of AS are identified -juvenile (JAC) and adult (AAC), depending on the age of the disease debut [7,9].
There are features of AS course that begans in childhood and adulthood [2,5,14], which, first of all, is manifested by the differences in the nature of the spinal column lesion [1,6]. At the same time there is a definite evolution of clinical manifestations of JAS in adult patients [8]. According to the literature, severe spine changes are rare in JAS [9], and involvement of the lumbar spine in the process, allegedly, is little typical for such patients [4,6]. A.Adrovic et al. [10] attributed the presence of asymptomatic sacroileitis and the absence of spondylopathy in the debut of JAS like the distinctive clinical signs in the contrast to AAC. It should be noted that the problem of clarifying the nature of spondylitis and sacroiliitis in the early stages of JAS is among the most relevant in pediatric rheumatology [11,15].
The purpose and objectives of the study: to study the clinical and radiological signs of the spondylopathy and sacroiliitis course in patients with AS, to evaluate their characteristics in the disease that began in childhood and adulthood.
All patients were divided into two groups: the first (main) amounted to 35 (16.1%) patients (all males) with onset of the disease under the age of 18 (JAS), and the others 182 (83.9%), with AAS were included in the 2nd (control) group. The age of the main group representatives in the disease debut was 14,3±0,52 years, and at the time of the examination -24,9±0,83 years, while in the control group it was 29,6±0,45 years and 40,2±0,58 years respectively. The duration of the disease in the 1st and 2nd groups did not differ. Both groups were approximately equal in the disease degree activity, but fast progressing course of the disease in AAS was 2,7 times more common.
The serum levels of antibodies to cyclic citrullinated peptide (aCCP), the concentration of interleukin (IL) 1 and tumor necrosis factor (TNF) were studied using the enzyme immunoassay (PR2100 Sanofi diagnostic pasteur, France), and the immuno-

RESULTS AND DISCUSSION
Sacroiliitis was determined in all patients with AS, and signs of spondylopathy -in 94.9% of them. It should be noted that JAS and AAS differed a little from each other in spinal cord lesions, correspondingly being 100,0% and 94,0% of cases. This also referred to the severity of spondylopathy, which indices were 0,69±0,084 points and 0,83±0,041 points respectively in the 1st and 2nd groups. In the case of JAS, changes in the cervical spine ( 2 =6,83, p=0,009) were more frequent by 33%, while in AAS, changes in lumbar region were twice as often ( 2 =33,33, p<0,001) and thoracic spine -by 19% ( 2 =5,60, p=0,018), whereas in the sacroileitis incidence, both groups did not differ.
Inflammatory, dishemic, mechanical and dysfixation character of painful spondylogenous syndromewas was established in 50,2%, 24,9%, 3,7% and 21,2%, respectively, of all patients with AS. The main and control groups differed a little from each other by the integral nature of pain, and also by the nature of vertebralgia.
It must be emphasized, as Wilcoxon-Rao multifactor analysis demonstrated, the severity of spondylopathy has a significant influence (p<0.001) on other integral signs of the disease both in the main (WR=8,06) and control (WR=5,21) groups, and there are direct regression relations with the severity of immune-inflammatory disorders (R=+1,96, p=0,045 and R=+7,60, p<0,001, respectively).
3. Involvement of the lumbar and thoracic spine in the process in patients with AAS is correspondingly more often by 2 times and by 19%, the appearance of dorsalgia -by 4 times, the restriction of the trunk lateral bendover -by 59%, while there are controversal dispersion-correlation links with extraarticular (systemic) manifestations of the disease.
4. Negative prognosis sign of spondylopathy in JAS is the high prevalence of peripheral articular syndrome, and in AAS -LI and PAI indices.
5. In the future it will be useful to predict the course of spine and sacroiliac joint lesions in AS patients with the disease onset in childhood and adulthood for subsequent timely rehabilitation activities, and the assessment of spondylopathy and sacroiliitis components nature may have practical importance as risk factors for separate extraarticular signs of the disease.
Conflict of interest. The authors declare that there is no conflict of interest, while the authors have not received financial support for research from individuals and organizations, fees and other forms of rewards.