Recognition of Juvenile Ankylosing Spondylitis in an Adolescent Female Presenting to a Chiropractor

Juvenile ankylosing spondylitis, a form of axial spondyloarthritis (axSpA), is an uncommon cause of chronic back pain in adolescents. We describe a 15-year-old female with a three-year history of chronic lumbosacral and hip pain, prolonged morning stiffness, nocturnal pain, and limited response to multiple conservative treatments, including physical therapy, medication, and injections. Previous lumbar magnetic resonance imaging (MRI) was virtually normal. On chiropractic evaluation, the combination of symptoms, chronicity despite conservative care, and lack of explanatory structural changes in the lumbar spine imaging raised suspicion for inflammatory sacroiliitis, leading to ordering of a pelvic MRI. This demonstrated bilateral structural lesions of the sacroiliac joints. Accordingly, the chiropractor prepared a referral to pediatric rheumatology, where the patient was diagnosed with juvenile ankylosing spondylitis and initiated on etanercept therapy with subsequent clinical improvement. This case underscores the challenges of diagnosing axSpA in adolescents and highlights the role of chiropractors as portal-of-entry clinicians in recognizing its signs and symptoms, pursuing appropriate imaging, and making timely referral when indicated.