NERVOUS SYSTEM LESION IN ANKYLOSING SPONDYLITIS, IN THE DISEASE BEGINNING IN СHILDHOOD AND ADULTHOOD

Abstract

The incidence of ankylosing spondylitis (AS) in population amounts to 0.3 %, which is significantly more likely to develop at the age of 20–30 years. There are two forms of AS – juvenile and adults, depending on the age of the disease debut. The problem of juvenile AS (JAS) diagnostics is one of the most relevant in pediatric rheumatology, and the evolution of this disease remains unexplored in adulthood. The aim of the study – to learn the frequency and nature of separate clinical signs of CNS and PNS lesions in patients with AS , and to evaluate their special features in the disease beginning in childhood and adulthood. Materials and Methods. 217 patients with AS (193 males and 24 females) with an average age of 38 years were examined. The rapidly progression course is detected in 21 % of patients, moderate and high activity rate – in 79 %, stage II–III – in 82 %, polyarthritis – in 65 %. JAS was noted in 16 % of cases (all boys), in which stage III took place twice as often than other patients. Results and Discussion. Changes in PNS are observed in 4.9 times more often among patients with JAS , and CNS is 2 times less often than in cases of the disease debut in adulthood, moreover among the patients of the 1st group, the severity of CNS disturbance is associated with the involvement of the cervical spine and the prevalence of spondylopathy, PNS is associated with the availability of tendovaginitis, arthritis of the "root joints" (shoulder, hip) and changes in the thoracic spine, while in the 2nd group it is associated with the parameters of the integral index of arthritis activity and the x-ray stage of the disease, with disturbance of "root" and sacroiliac joints, wherein the age of the disease onset affects the development of asthenic vegetative and corticonuclear syndrome, the emergence of radiculopathy, cervicocranialgia and metacarpal canal syndrome, and in the pathogenetic architectonics of the CNS pathology the level of immunoglobulin-A plays a greater role, and in PNS the serum interleukin 1-β contents, which, in addition, in cases of JAC determine the occurrence of cervicocranialgia, and in the remaining observations of AS – the Morton's metatarsalgia. Conclusions. AS with different age of the disease debut is a risk factor for the development of certain symptoms of the CNS and PNS disturbances, which in these groups have their pathogenetic features.

Keywords

• ankylosing spondylitis
• children
• adults
• nervous system
• lesion
• course.