Clinical outcomes and progression to orthopedic surgery in juvenile- versus adult-onset ankylosing spondylitis

Deepak R. Jadon, Gavin Shaddick, Amelia Jobling, Athimalaipet V. Ramanan, Raj Sengupta

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20 Citations (SciVal)


Objective Juvenile- and adult-onset ankylosing spondylitis (AS) are subtypes of AS that may have different clinical outcomes. We compared cohorts of juvenile-onset AS and adult-onset AS in terms of clinical characteristics, clinical outcomes, proceeding to AS-related orthopedic surgery, and type of orthopedic surgery. Methods A retrospective cohort study was conducted of all AS patients attending a teaching hospital. Demographics, clinical parameters, and history of AS-related orthopedic surgery to the spine, root, or peripheral joints were recorded. Differences between surgery for juvenile- and adult-onset AS patients, and effects of covariates were assessed using logistic regression and survival analyses. Results A total of 553 AS patients were studied: 162 juvenile-onset AS and 391 adult-onset AS cases. After adjusting for significant covariates, adult-onset AS cases were less likely to proceed to surgery (odds ratio [OR] 0.31, P < 0.001), have a hip procedure (resurfacing or arthroplasty; OR 0.374, P = 0.001), and have hip arthroplasty (OR 0.43, P = 0.01). Significant differences were also observed when comparing Kaplan-Meier survival curves (P = 0.001) and using Cox proportional hazards regression (P = 0.002). A history of smoking was not associated with surgery. AS cases with older age at symptom onset were far less likely to have surgery than those with younger onset, in a nonlinear manner. Conclusion Juvenile-onset AS cases are more likely than adult-onset AS cases to proceed to hip arthroplasty, but equally likely to have hip resurfacing and hip arthroplasty revision/re-revisions. Smoking was not associated with the risk of orthopedic surgery. Orthopedic surgery was unlikely after 40 years of disease in both subsets.

Original languageEnglish
Pages (from-to)651-657
Number of pages7
JournalArthritis Care and Research
Issue number5
Early online date24 Apr 2015
Publication statusPublished - May 2015


  • Adolescent
  • Adult
  • Age of Onset
  • Arthroplasty, Replacement, Hip
  • Chi-Square Distribution
  • Child
  • Disease Progression
  • Disease-Free Survival
  • England
  • Female
  • Hospitals, Teaching
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Nonlinear Dynamics
  • Odds Ratio
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Spondylitis, Ankylosing
  • Time Factors
  • Young Adult
  • Comparative Study
  • Journal Article


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