Most cases of juvenile-onset ankylosing spondylitis migrate to adulthood and can also eventually present with the characteristic changes of imaging sacroiliitis. However, juvenile-onset ankylosing spondylitis is prone to misdiagnosis or underdiagnosis due to atypical symptoms, and there are many differences in clinical presentation and functional prognosis between juvenile-onset ankylosing spondylitis and adult-onset ankylosing spondylitis. The symptoms of juvenile ankylosing spondylitis are intricate and complex, and there are four main clinical manifestations: 1, peripheral arthritis, which mainly manifests as asymmetric monoarticular or oligoarticular arthritis of the lower limbs, and is most common in the hip and knee joints, followed by the ankles, elbows, and small joints of the hands and feet. Peripheral tendinitis is mainly characterized by pain in the position where the tendon attaches to the bone, such as heel pain, sciatica and other parts. The following figure includes the common attachment point inflammation location of ankylosing spondylitis. 3, central axis involvement Mainly manifested as pain in sacroiliac joints, lumbar, thoracic, cervical and other central axis areas, usually chronic dull pain in the lower back, often felt in the buttocks or deep sacroiliac area, or only manifested as morning stiffness in the back, which is relieved after activities. Compared with adult-onset ankylosing spondylitis, juvenile ankylosing spondylitis is more likely to have extra-articular systemic manifestations, such as fever and emaciation. Other extra-articular manifestations include weight loss, anemia, anterior uveitis, and inflammatory bowel disease. Treatment of Juvenile Ankylosing Spondylitis For the treatment of juvenile ankylosing spondylitis, the first line of medication remains NSAIDs. NSAIDs not only reduce inflammatory symptoms such as pain and swelling, but also slow or stop joint destruction. Combination of disease-modifying anti-rheumatic drugs (DMARDs) can stabilize the disease and reduce joint destruction and disability, such as methotrexate, salazosulfapyridine, etc., and biologics (e.g., tumor necrosis factor antagonists) can be used in severe cases. What is the best medicine for ankylosis? –Drug therapy interpretation of less joint type patients intra-articular injection of corticosteroids is conducive to reducing inflammation, improve joint function, for example, local injection of knee arthritis has a better effect. However, we should also pay attention to the fact that the same joint cavity should not be injected more than 3 times in 1 year, and excessive puncture is prone to complications of infection, local subcutaneous tissue atrophy, hypopigmentation and subcutaneous calcification phenomenon. Joint cavity injections in younger children involve anesthesia and precise positioning, and should be performed under the guidance of a specialist. Arthrocentesis, do you understand it? What can parents do about ankylosis? Many people are very concerned about early prevention and detection of the disease in their children, hoping that early screening will prevent their children from experiencing such pain again. However, there is no clear and effective prevention method for ankylosing spondylitis. If your child is asymptomatic, early screening, except for HLA-B27, other tests are not meaningful. For example, the abnormalities of X-ray and CT of sacroiliac joints usually appear after 7~8 years of the disease, if there are no symptoms, both of them should be normal, and the filming will instead bring unnecessary radiation damage to the child; MRI of sacroiliac joints is even more unnecessary because when the child is growing up, the bone marrow activity is very active, and the bone marrow of a normal toddler will be able to show images similar to bone marrow edema, which cannot be distinguished in the MRI is impossible to identify, but instead the family will see the high signal in the sacroiliac joints will bring unnecessary anxiety and confusion. Therefore, our suggestion is (only represents personal opinion): those who are worried that their children will also develop ankylosis should not be too anxious, not to mention not to be afraid of life, we should know that over-protection will also affect the healthy growth of the child, so that the child can live a normal life and participate in sports activities, no matter whether it will develop or not in the future, it is good for his physical and mental health. If you have to say that you need to pay attention to something, it is recommended to pay attention to dietary hygiene to avoid intestinal infections induced by the occurrence of joint-type diseases. Even HLA-B27-positive strong friends is not necessary to prematurely check the child’s HLA-B27 gene, because, if the child does not have joint pain, low back pain and other symptoms, even if the child is found to be HLA-B27-positive, it is not necessarily get strong ankylosis (only about 20% of the probability of the disease will be), and can not be taken in advance to prevent the medication. Of course, if the child has pain symptoms, they should go to the rheumatology department of the Children’s Hospital in time, and should not avoid medical treatment.