Shoulder, knee, and hip pain as initial symptoms of juvenile ankylosing spondylitis: a case report

Ankylosing spondylitis is a systemic disease typically manifested by persistent back pain or stiffness unrelieved by rest. Although not often recognized, ankylosing spondylitis can also cause peripheral joint pain, particularly in the hips, knees, ankles, and shoulders. In the pediatric form of the disease, juvenile ankylosing spondylitis, peripheral joint involvement is more frequent and can precede, by many years, the onset of back symptomatology. The following case is an example of a teenager who presented to physical therapy with a variety of common peripheral joint complaints over a 3-year period. Eventually, he was diagnosed with juvenile ankylosing spondylitis. Lack of awareness of the manifestations of ankylosing spondylitis and juvenile ankylosing spondylitis may lead to significant delay in diagnosis and initiation of appropriate therapy. A physical therapist may be the first health professional to assess a patient's lack of response to treatment for a seemingly typical diagnosis and should be aware of potential alternate diagnoses.