A systematic study on the elevated risk of ankylosing spondylitis in adolescents engaged in intense physical exercise

This study investigates the link between intense physical activity during adolescence and the onset of ankylosing spondylitis (AS), particularly in individuals having the human leukocyte antigen (HLA)-B27 antigen, a known genetic marker for AS. The systematic literature review included studies published between 2014 and 2024. . Keywords and search terms included combinations of "ankylosing spondylitis," "HLA-B27," "adolescence," "intense physical exercise," and "genetic predisposition. Inclusion criteria focused on studies involving adolescents aged 15-24 years with genetic predispositions such as HLA-B27. Exclusion criteria included studies with unrelated outcomes such as individuals not within the target adolescent age range, non-peer-reviewed articles, and those with insufficient data on the target population. Findings revealed that adolescents with the HLA-B27 antigen who engaged in heavy weight exercise were at a heightened threat of developing AS. The mechanical stress from intense physical activity potentially triggered or exacerbated inflammation at entheses in genetically predisposed individuals. However, the onset of AS was not universally observed in all HLA-B27 positive individuals who participated in strenuous exercise, suggesting other genetic and environmental factors’ involvement. The study suggests that strenuous exercise during adolescence may act as a significant contributing factor to the onset of AS in individuals having a genetic predisposition such as HLA-B27. While not all individuals having HLA-B27 develop AS, genetic and environmental factors’ combination, including intense physical activity, may accelerate disease progression.