Spondylodiscitis and ankylosing spondylitis: HLA typing and nosological implications.

Nine cases from among 64 patients with ankylosing spondylitis (AS) are described. In addition to bilateral sacroiliitis these cases had a peculiar type of spondylodiscitis characterised by quite diffuse and marked sclerosis of multiple vertebral bodies, with only minimal erosions of the adjacent vertebral plates while classical syndesmophytosis was absent. The antigen HLA-B27 was found only in 1 of these 9 cases. This type of spondylodiscitis could discriminate among all the patients with AS a subgroup with a peculiar clinical pattern and a probably distinctive pathological mechanism.     

Scintiscanning in ankylosing spondylitis: a clinical, radiological and quantitative radioisotopic study

Twenty-six patients with ankylosing spondylitis and 10 control subjects had quantitative dorso-lumbar and sacroiliac scintigraphy performed using 99mtechnetium methylene diphosphonate. No difference was found in the mean uptakes of radionucleide at each vertebral level or in the sacroiliac joints between the diseases patients and controls. No correlation was found between radionucleide uptake and radiological score, pain and tenderness assessments. The large variation in quantiative measurements resulted in a large overlap between control and diseased patients and it is unlikely that scintigraphy will be of diagnostic value in the absence of improved methodology.     

Sulphasalazine in ankylosing spondylitis. A radiological,clinical and laboratory assessment

Summary In a 12-month double-blind placebo-controlled trial, the effect of sulphasalazine was studied in 40 patients with ankylosing spondylitis. The treatment group showed significant improvement in pain, stiffness, sleep disturbance (p<0.05), finger/floor distance, erythrocyte sedimentation rate, C-reactive protein, orosomucoid and IgA levels (p<0.01). There was improvement in sleep disturbance (p<0.05), finger/floor distance and erythrocyte sedimentation rate (p<0.01) in the placebo group. Sulphasalazine did not retard radiological progression as measured either by plain X-ray or computerised tomographic scans. Multiple analysis of variance did not show a significant difference in disease activity indicators between the 2 groups.     

Osteitis condensans ilii: prevalence and characteristics of a neglected mimic of sacroiliitis

Clinical Rheumatology - Osteitis condensans ilii (OCI) is a benign condition characterised by triangular sclerosis of the iliac bone which may mimic radiographic sacroiliitis. Prevalence is...     

Comparison of radiological indices (SASSS, M-SASSS, BASRI-s, BASRI-t) in patients with ankylosing spondylitis

This study was performed to compare radiologic methods of Bath Ankylosing Spondilitis Radiology Index-spine (BASRI-s), Bath Ankylosing Spondilitis Radiology Index-total (BASRI-t), Stoke Ankylosing Spondilitis Spine Score (SASSS) and Modified Stoke Ankylosing Spondilitis Spine Score (M-SASSS) and to test their superiority over each other. Eighty-one patients (60 males, 21 females) with ankylosing spondylitis (AS) were included in the study. Patients were evaluated for their functional status, disease activity, quality of life, and spinal mobility using Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), AS Quality of Life Index (ASQoL) scale, and Bath AS Metrology Index (BASMI), respectively. Radiographs of the patients were evaluated using BASRI-s, BASRI-t, SASSS, and M-SASSS methods. Spearman’s correlation test was used for the correlation analysis. Significant correlations were found between the duration of disease with radiological indices (P?<?0.05), BASMI with SASSS (P?<?0.01), M-SASSS (P?<?0.01), BASRI-s (P?<?0.01), and BASRI-t (P?<?0.01). Furthermore, there were correlations between BASFI with SASSS (P?<?0.05), M-SASSS (P?<?0.05), BASRI-s (P?<?0.05). and BASRI-t (P?<?0.05). According to the results of our study, among these four radiological measuring methods, SASSS appears to be the one that is the least reflective of patient status. The reason to that is the fact that while in SASSS method only lumbosacral radiography is evaluated, in other methods one more area is evaluated. However, the disadvantages of BASRI methods relative to others, in BASRI methods, patients are exposed to more radiation.     

Radiological manifestations in 200 patients with ankylosing spondylitis: correlation with clinical features and HLA B27.

The radiological manifestations of 200 patients with ankylosing spondylitis were appraised, and correlated with the patient's sex, anterior uveitis, and HLA B27. Radiological findings in female patients were no different from male patients. Only syndesmophyte formation in the spine was found significantly more frequently in patients with uveitis and HLA B27. Osteoporosis of the spine correlated strongly with a later age of onset, longer duration of the disease, older age at the time of study, Romanus lesions, syndesmophytes, spinal fusion, osteitis pubis, and widespread radiological destructive peripheral joint disease. Syndesmophytes were most frequently present at the dorso-lumbar junction. Spondylodiscitis was present in 8 patients and was most commonly present in the thoracic spine.     

Comparison of clinical features in HLA-B27 positive and negative patients with ankylosing spondylitis

The clinical features of ankylosing spondylitis (AS) were compared in 63 HLA-B 27 positive (+) and 15 B27 negative (-) individuals with this disease. There were no differences in age at onset, functional class, degree of deformity, pain, severity of X-ray changes, or frequency of peripheral joint involvement or of reconstructive orthopedic surgery. These data demonstrated that skeletal manifestations of AS were essentially the same in B27(+) and (-) patients, and provide no evidence for the speculation that AS in B27(-) patients is milder or is a different disease from that occurring in B27(+) patients. On the other hand, acute anterior uveitis was found to be significantly more common in B27(+) patients, a fact suggesting that the "uveitis of AS" may in fact be an independent condition occurring in B27(+) individuals, rather than a manifestation of AS per se.     

Hla-d locus typing in ankylosing spondylitis and reiter's syndrome

HLA-D typing of 44 patients with ankylosing spondylitis (AS) and 31 patients with Reiter's syndrome (RS) did not show increased frequency of any particular Dw allele in either population of patients as compared to controls. Such studies also allowed each patient's general response to be compared with other general responses within each experiment. Contrary to reports of diminished lymphocyte responses in AS patients, hyperresponsiveness in both AS and RS patients was found.     

Correlation of HLA B27 subtypes with clinical features of ankylosing spondylitis

Aim: The aim of the present study was to identify the B*27 subtypes associated with ankylosing spondylitis (AS) in our population and correlate them with clinical features of AS. Method: Whole blood samples were collected from 81 HLA‐B27 positive AS patients and 29 controls (asymptomatic healthy unrelated individuals) positive for HLA‐B27. Clinical details of the patients were recorded which included history of inflammatory back pain, sacroiliitis, spine involvement, enthesitis, peripheral arthritis and uveitis. HLA‐B27 subtypes were detected using commercially available techniques. Fisher’s exact test was used for statistical analysis. Results: The subtypes observed in AS patients were B*2705 (67.9%, 55/81), B*2704 (28.4%, 23/81), B*2707 (2/81) and B*2702 (1/81). Subtypes in the controls were B*2705 (62.07%, 18/29), B*2707 (27.59%, 8/29) and B*2704 (10.34%, 3/29). Uveitis was observed more in B*2704‐positive AS patients (34.78%, 8/23) compared to B*2705‐positive AS patients (16.36%, 9/55). However, the difference was not statistically significant (P = 0.130). No major differences were found between B*2705 and B*2704 for other clinical features. Conclusion: B*2705 was the main subtype observed in both patient and control groups. Frequency of B*2704 was more in AS patients compared to controls. Occurrence of AS‐associated uveitis was more often in B*2704‐positive AS patients compared to B*2705‐positive ones.     

Acetabular osteitis in ankylosing spondylitis: does fibrillin figure in its pathogenesis?

In the hip and sacroiliac joints, ankylosing spondylitis attacks the acetabulum over the femoral head and the ilium in preference to the sacrum. Both sites involve inflammation in bone subjacent to fibrocartilage with relative sparing of opposing, hyaline cartilage-surfaced mates. This disease appears to target connective tissues rich in fibrillin-1. A cell-mediated autoimmune response may be involved.     

Clinical characteristics of patients with ankylosing spondylitis in India

This study focuses on describing full spectrum of clinical, laboratory, and radiological characterization of ankylosing spondylitis (AS) patients in India. Data on 70 consecutive AS patients, seen at the rheumatology clinic in India, was prospectively obtained using investigator-administered questionnaires. Diagnosis was made according to the modified New York criteria. The core set of variables selected by Assessment in AS International society were obtained. The differences in clinical characteristics based on presence or absence of peripheral arthritis, gender, and juvenile (JOAS) vs. adult onset AS (AOAS) were evaluated. The male/female ratio was 5:1. The mean age of onset of symptoms and diagnosis were 23.6 and 32.5 years, respectively. Females had similar spinal indices and radiological damage as male counterpart. However, they had more common extra-articular manifestations and root joint involvement. The majority of patients consisted of AOAS (78.5%) and was clinically similar to JOAS. One or more peripheral joints were involved in 65.7% of patients, affecting predominantly the lower extremity (90.6%, knee 47.1%, and ankle 35.7%) in asymmetrical pattern (78%). Patients with peripheral arthritis had higher erythrocyte sedimentation rate, more frequent enthesitis, root joint, and whole spine involvement, suggesting more aggressive disease. Most common site of enthesitis was chondro-sternal junction (30%) and Achilles tendonitis (24.3%). The root joints frequently involved extra-axial joints. Uveitis was the most common extra-articular manifestation (25.7%). The predominant initial symptom was typical inflammatory low back pain (87.1%). Assessment in ankylosing spondylitis indices showed a moderately severe disease activity and damage with following values: mean Bath Ankylosing Spondylitis Disease Activity Index, 3.2 (±1.8); mean Bath Ankylosing Spondylitis Functional Index, 2.3 (±2.0); and mean Bath Ankylosing Spondylitis Metrology Index, 3.15 (±2.3). Majority of the patients had bilateral sacroiliitis (grades 2–4) on radiographs (87.1%). In conclusion, the features of AS in Indian patients were broadly similar to other part of world, with the exception of increased frequency of peripheral arthritis.     

Association of neuropathic-like pain characteristics with clinical and radiographic features in patients with ankylosing spondylitis

Clinical Rheumatology - Ankylosing spondylitis (AS) is a chronic, progressive, and inflammatory disorder and causes chronic back pain. It is not unusual for patients with AS to have symptoms...     

Ankylosing spondylitis and inflammatory bowel disease. III. Clinical characteristics and results of histocompatibility typing (HLA B27) in 50 patients with both ankylosing spondylitis and inflammatory bowel disease.

A study was made, in co-operation with several gastroenterology and rheumatology centres, of the clinical and genetic characteristics (HLA B27) of 50 patients suffering from both inflammatory bowel disease (38 Crohn's disease (CD), 12 ulcerated colitis (UC)) and ankylosing spondylitis (AS), the latter diagnosis being established according to the New York criteria. 20 CD (52.6%) and 8 UC (66.7%) patients were HLA B27 positive. The presence of HLA B27 was studied in relation to clinical parameters, such as first occurrence of symptoms of AS or inflammatory bowel disease (IBD), a history of peripheral arthritis, iridocyclitis, and a positive history of AS or IBD. Our patients were found to have heterogeneous clinical features: on one side of the spectrum a group of cases was distingiushed with the typical characteristics of idiopathic AS, often being HLA B27 positive. On the other side a smaller group of HLA B27 negative patients was observed, with severe intestinal inflammatory pathology, lacking most of the typical clinical features of idiopathic AS ('secondary' form of AS). Finally, between these two extremes a group of patients was found with less pronounced clinical or genetic characteristics. These different clinical and histocompatibility patterns suggest a mixed aetiopathogenesis of AS in IBD patients. Such a 'syndrome' of AS might harbour both idiopathic AS and forms of AS 'secondary' to the intestinal inflammatory pathology.     

Polymorphonuclear cell motility, ankylosing spondylitis, and HLA B27.

Polymorphonuclear leucocyte (PMN) function was studied in 29 subjects with ankylosing spondylitis (AS). Of these, 20 were HLA B27+ve and 9 B27-ve. There were 30 controls and, of these, 15 were B27+ve. Random and directed cell migration was measured by 2 techniques: migration through a micropore filter and migration under an agar film. The chemo-attractant was either case in-activated serum or zymosan-activated serum. By both techniques directed motility was increased in subjects with B27 or with AS when compared to the B27-ve controls. This suggests that the disease AS and the possession of B27 are both associated with increased PMN motility.     

HLA-D locus typing in ankylosing spondylitis and Reiter's syndrome.

HLA-D typing of 44 patients with ankylosing spondylitis (AS) and 31 patients with Reiter's syndrome (RS) did not show increased frequency of any particular Dw allele in either population of patients as compared to controls. Such studies also allowed each patient's general response to be compared with other general responses within each experiment. Contrary to reports of diminished lymphocyte responses in AS patients, hyperresponsiveness in both AS and RS patients was found.     

Comparison of non-radiographic axial spondyloarthritis and ankylosing spondylitis patients in Malaysia

Aim of the workThis study aimed to compare the clinical features, associated comorbidities and treatment patterns of ankylosing spondylitis (AS) patient to those with non-radiographic axial spondyloarthritis (nr-axSpA) in Malaysia.Patients and methodsThis study was conducted in multiple rheumatology centre in Malaysia. Patients with axial spondyloarthritis (axSpA) were included. The AS and nr-axSpA group were compared.ResultsA total of 302 AS patients and 43 nr-axSpA patients were included. The age was comparable (41.7 ± 12.4 vs 38.5 ± 14.3 years; p = 0.13) however the male:female in those with AS was 4.8:1 vs 1.2:1 (p < 0.0001). The diagnostic delay was longer in AS patients (6.04 ± 6.6 vs 3.4 ± 7.3; p = 0.03), more were frequently smoking (50.3 % vs 25.6 %; p = 0.003), were Chinese (56.6 % vs 37.2 %; p = 0.02), had a higher frequency of HLA-B27 (p < 0.0001) and family history of axSpA (p = 0.04).More AS patients experienced inflammatory back pain (p < 0.0001), had higher Bath AS Metrology Index (BASMI) (p < 0.0001) and Bath AS functional index (BASFI) (p = 0.04). Nr-axSpA patients more likely to experience dactylitis (16.3 % vs 5.6 %; p = 0.014) but no significant differences in frequency of enthesitis. The frequency of comorbidities was similar in both groups. The use of non steroidal anti inflammatory drugs was more frequent in AS (p = 0.038) while nr-axSpA patients more likely to receive conventional disease modifying antirheumatic drug (p = 0.002).ConclusionAS and nr-axSpA shared some characteristics but also had some significant difference especially on gender, inflammatory back pain and HLA-B27. This study offers a better understanding of both the subtypes of axSpA in Malaysia.