Evaluating juvenile ankylosing spondylitis: A possible case from the central plains of Ming-Qing China

To evaluate axial and peripheral joint lesions in a late adolescent/young adult skeleton and assess whether they support a diagnosis of juvenile-onset ankylosing spondylitis.

Individual M55, a possible male aged 16.5-20 years, recovered from a Ming-Qing period tomb (14th-20th century CE) at the Dabuzi cemetery, Shaanxi, China.

Macroscopic observation was used to record skeletal pathologies. Differential diagnosis focused on inflammatory spondyloarthropathies and related arthropathies.

The preserved thoracic and lumbar vertebrae show multi-level posterior ankylosis of the zygapophyseal joints, with fusion of the costovertebral and costotransverse joints. Erosive and irregular lesions affect the shoulders, hips, knees, and other peripheral joints. Ossified ligamentous tissue occurs superior to the right auricular surface, although the sacroiliac joints are poorly preserved. Manubriosternal fusion and active periosteal reactions are also present.

The lesion distribution is most consistent with possible juvenile-onset ankylosing spondylitis, but incomplete preservation prevents a definitive diagnosis.

This case provides a diagnostic model for evaluating juvenile inflammatory spondyloarthropathy in incomplete archaeological remains, especially when the sacroiliac joints, hands, and feet are absent or poorly preserved.

Observations are macroscopic and lack radiographic, CT, or biomolecular confirmation.

Imaging, comparative screening, and biomolecular analysis may clarify disease attribution and broader patterns of inflammatory joint disease.