Can children also get ankylosing spondylitis? How can patients with ankylosing spondylitis prepare for pregnancy scientifically?

Author: Wu Husheng, Chief Physician of the Seventh Medical Center of the General Hospital of the Chinese People's Liberation Army

Reviewer: Zhang Zhuoli, Chief Physician, Peking University First Hospital

Ankylosing spondylitis is a chronic inflammatory disease, and the cause is still unclear. It first affects the sacroiliac joints, causing back pain, which gradually progresses upwards and eventually develops into full spinal fibrosis and ankylosing spondylitis. It also affects other systems throughout the body, and in severe cases can cause deformities and affect life.

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Ankylosing spondylitis has a long course, lasts a lifetime, and cannot be cured. However, it generally does not shorten life expectancy. In a few cases, it affects important organs such as the heart and lungs, which increases the risk of death, so people often call it the immortal cancer. Ankylosing spondylitis can occur at any age, with the highest incidence age being 20-30 years old.

So, can children also get ankylosing spondylitis? Children can also suffer from ankylosing spondylitis, also known as juvenile ankylosing spondylitis, and it tends to cluster in families, that is, there are often patients with ankylosing spondylitis or other rheumatic immune diseases in the family of the child. Most cases of ankylosing spondylitis in children often start in peripheral joints, with the knee, hip, ankle, shoulder, elbow, and wrist joints being the most common sites. It is characterized by asymmetric unilateral arthritis and tendinitis, which are important signs of ankylosing spondylitis in children, and often the spinal joints are not affected until many years after the onset of the disease. In contrast, adult ankylosing spondylitis rarely invades peripheral joints, and most of the time the axial joints are affected.

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When children have back pain, joint swelling and pain, especially pain in the large joints of the lower limbs or ankles; if other family members have ankylosing spondylitis, psoriasis and other diseases, they should be alert to ankylosing spondylitis and seek medical attention in time to get a clear diagnosis. The treatment principles for ankylosing spondylitis in children are basically the same as those for adults.

What should patients with ankylosing spondylitis pay attention to when getting pregnant? The peak age of ankylosing spondylitis is 20-30 years old, which is the marriage and childbearing stage. Whether male or female patients, their reproductive organs and reproductive functions are not affected, and they can give birth like normal people, especially in the early stages of the disease, when there is no joint or spinal deformity, there is basically no effect on pregnancy.

If ankylosing spondylitis patients want to have children during treatment, their condition must first be stable. If the condition is in the acute stage or is not effectively controlled, it is not recommended to have children because there are certain drug residues in the body, which cannot guarantee the quality of sperm and eggs, and is not conducive to eugenics. Some drugs have teratogenic risks, such as methotrexate and leflunomide. It is recommended to stop using them for 3-6 months before preparing for pregnancy. If ankylosing spondylitis patients want to have children, they must stop or reduce the medication under the guidance of a doctor, and prepare for pregnancy when the doctor believes that they can have children, so that they can give birth to a healthy baby. For patients in the late stage of the disease, severe joint or spinal deformities have occurred, and they cannot take care of themselves, pregnancy and delivery will be more difficult, and pregnancy should be carefully considered.

Many patients with ankylosing spondylitis are worried about whether they will pass on the disease to their children if they get pregnant and have children. Is it highly hereditary? The cause of ankylosing spondylitis is still unclear, and it is believed to be the result of the combined effects of genetic factors, environmental factors, and immunological factors. Ankylosing spondylitis has a certain familial clustering, and the onset is directly related to the HLA-B27 gene. However, among the HLA-B27 positive population, most do not develop the disease, indicating that in addition to genetic factors, the influence of other factors is also very important.