1. Juvenile ankylosing spondylitis. In childhood, AS usually presents in older boys as an asymmetric oligoarticular arthritis of the lower extremities, often predating back symptoms. Heel pain is a common complaint. However, with time, the child acquires more typical features of adult AS. Almost all children affected are positive for HLA-B27.
2. Asymptomatic sacroiliitis. Among asymptomatic HLA-B27-positive relatives of probands with AS and among random asymptomatic persons who are HLA-B27-positive, 20% may be found to have radiographic sacroiliitis. Also, about one-fourth of HLA-B27-positive patients with acute anterior uveitis will have subtle clinical or radiographic evidence of sacroiliitis. Some of these patients may progress to overt clinical disease.
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