Ankylosing spondylitis associated with osteoporosis and vertebral deformity

Summary We report a 56-year old man with ankylosing spondylitis associated with osteoporosis and vertebral deformity.     

Ankylosing spondylitis in two Zaïrian brothers

Summary Ankylosing spondylitis has never been described in Zaïre and is considered to be rare in black African populations. We report two cases observed in the University Hospital of Kinshasa. The two patients are brothers. The diagnosis is based on anaemnestic, clinical and radiological findings. We therefore demonstrate the existence of this disease in Zaïre and presume that other similar cases may be diagnosed.     

A destructive discovertebral lesion: Septic discitis,ankylosing spondylitis,or rheumatoid arthritis ?

Summary A 41-year-old male with a 20-year history of classical ankylosing spondylitis, psoriasis and seropositive, nodular erosive rheumatoid arthritis presented with a 12-month history of thoracolumbar junction pain following minor trauma. A pseudoarthrosis was noted at the T11/12 level on plain radiographs and tomograms. A gallium scan showed no increased isotope uptake, and a computed tomogram (CT) revealed no evidence of a paraspinal collection. Conservative management including cast immobilisation and local radiotherapy was ineffective, and spinal fusion was required. A typical Andersson lesion was found at operation. The diagnostic and therapeutic problems of such discovertebral lesions are discussed.     

Ankylosing spondylitis presenting with macrophage activation syndrome

Macrophage activation syndrome (MAS), which can also be considered as reactive hemophagocytic syndrome (HPS), is a rare and potentially fatal complication of rheumatic diseases. We describe a 42-year-old woman in whom MAS developed as a complication of ankylosing spondylitis (AS). She suffered from fever and low back pain before admission. Laboratory findings were pancytopenia, abnormal liver enzymes, increased ferritin levels, and positive for B27. Hyperplasia of hemophagocytic macrophages was confirmed in her bone marrow. High-dose steroids therapy resulted in clinical and laboratory improvements. In this patient, there was no possible causative factor of HPS (such as viral infection, lymphoma, and systemic lupus erythematosus) except the presence of AS. There have been no previously reported cases describing the relationship between AS and HPS. This case indicates that attention should be given to the possibility that certain patients with AS-associated cytopenia may display accompanying intramedullary hemophagocytic phenomena.     

Dermatoglyphics and ankylosing spondylitis

Summary Dermatoglyphics the epidermal ridge configurations of the fingers, toes, palms and soles, not only help identify individuals, but have been proved to give important information about some genetic disorders. This study was aimed at finding a possible correlation between the dermatoglyphic differences in patients with ankylosing spondylitis (AS) and the HLA B27 antigen. The dermatoglyphic patterns of AS patients were compared with the data of control subjects. Significant dermatoglyphic abnormalities were found, but there proved to be no connection between the HLA B27 antigens. We therefore conclude that HLA B27 does not contribute to the development of dermatoglyphic abnormalities. It seems, however, that our findings provide some new nosographic information to the natural picture of AS.     

Ig A antibodies to klebsiella in ankylosing spondylitis

Summary In this study anti-klebsiella Ig A values were compared in 40 patients with definite diagnosis of ankylosing spondylitis and a control group of 40 healthy subjects. Anti-Klebsiella Ig A antibody values were significantly higher in patients with ankylosing spondylitis as compared to the control group (p<0.001). Correlation between these antibodies and erythrocyte sedimentation rate, CRP, serum Ig A, HLA B 27, age, sex and disease duration was searched, but no correlation was found. In our opinion, these results support the suggestion that inflammatory response in ankylosing spondylitis is triggered by Klebsiella but is insufficient to prove the causal relationship between ankylosing spondylitis and Klebsiella.     

Dickkopf-1 in ankylosing spondylitis: Relation to spinal dysmobility and radiographic findings

Back groundDickkopf-1 (DKK-1) is an inhibitory molecule that regulates Wnt pathway, which is critically important in osteoblastic new bone formation, therefore it may play a role in the process of new bone formation in Ankylosing Spondylitis (AS).Aim of the workTo measure serum level of DKK-1 in AS patients and study the relation between these levels with disease activity, spinal dysmobility and radiographic findings.Patients and methodsThirty AS patients as well as 20 healthy subjects as a control group were included in this study. DKK-1 serum levels were measured using ELISA technique, disease activity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, radiographic assessment by Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-s) and modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS).ResultsDKK-1 was not correlated to ESR, CRP or BASDAI (p > 0.05) and was negatively correlated to BASRI-s and mSASSS (p < 0.001), though DKK-1 serum level was unexpectedly higher in patients versus control (p < 0.001). On comparing HLA-B27 positive and HLA-B27 negative patients, there were a significant increase in BASRI-s and mSASSS and decrease in DKK-1 level in those with positive HLA-B27 (p < 0.05). On comparing patients received anti TNF therapy and those not received anti TNF therapy, there was no significant difference in DKK-1 level (p > 0.05).ConclusionOur finding suggests dysfunction of DKK-1 in patient with AS.     

Evaluation of internal consistency and re-test reliability of Bath ankylosing spondylitis indices in a large cohort of adult and juvenile spondylitis patients in Taiwan

The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Global Score (BAS-G) have been recommended for evaluating function and disability in patients with ankylosing spondylitis (AS). The aim of this study was to develop a Chinese version of the BASDAI, BASFI, and BAS-G and assess their reliability and validity. The Chinese version was obtained after a translation and back-translation process. A total of 447 patients with adult and juvenile AS were assessed using these three instruments. Reliability was tested by internal consistency and test-retest reliability. Internal consistency of the instrument was given as Cronbach's alpha. Test-retest reliability was assessed by intraclass correlation coefficient. To assess the sensitivity to change, 153 patients were included in an 8-week follow-up study. In our analysis, the reliability of these three instruments-the BASDAI, BASFI, and BAS-G-for a 24-h test-retest showed acceptable intraclass correlation coefficients (0.92-0.94). Our Chinese versions of the BASDAI, BASFI, and BAS-G also showed 0.87, 0.94, and 0.90, respectively, with Cronbach's alpha coefficient, indicating good reliability. For sensitivity to change in 8-week follow-up, all three instruments showed 5.0 to 5.4% changes. Our Chinese versions of the BASDAI, BASFI, and BAS-G showed adequate reliability, validity, and responsiveness to clinical change. Thus, disease activity and functional status in Chinese-speaking patients with AS may be adequately evaluated with these versions of the original instruments.     

An epidemiological survey of the signs and symptoms of ankylosing spondylitis

Summary An epidemiological survey of ankylosing spondylitis (AS) was performed in Tromsø, Northern Norway. Altogether 27 cases of AS were found, and the symptoms and signs of these subjects were compared to those of persons with back pain but not suffering from AS (NON-AS). The symptoms which differentiated best between AS and NON-AS were: back pain which awakened the subject at night and made him leave the bed, back pain not relieved by lying down but improved by exercise, back pain of 3 months duration or more and morning stiffness lasting 0.5 hours or more. Reduced lateral mobility of the lumbar spine, a total spinal extension of 20° or less and a total spinal flexion of 40° or less were signs of acceptable value for the diagnosis of AS. Clinical criteria for the diagnosis of AS, to be used both in the clinical management of patients with back complaints and in population surveys of AS are suggested.     

Ankylosing spondylitis. An unusual manifestation of familial Mediterranean fever. Report of a case complicated by amyloidosis and polyneuropathy

Summary We report a case of familial Mediterranean fever (FMF) with typical clinical and roentgenological findings of ankylosing spondylitis. The spinal involvement in FMF is discussed. A second unusual feature of this case is the occurrence of polyneuropathy which could possibly be ascribed to the slowly evolving amyloidosis during continuous colchicine treatment.     

Clinical study of Thai patients with ankylosing spondylitis

Summary Sixty-one Thai patients with ankylosing spondylitis (AS), diagnosed in accordance with Rome and New York criteria for AS, were studied. The cases includes idiopathic AS (46 cases), Reiter's syndrome AS (8 cases) and psoriatic spondylitis (7 cases). The vast majority of patients were male (MaleFemale = 11.21), and in over three-fourths the age of onset was between 10 and 39. Low back pain and peripheral arthritis as the initial manifestations were observed in 78.68 and 55.73% of patients respectively. Peripheral arthritis was evident during the course of illness in 72.13 % of cases, oligoarticular arthritis being predominant (68.97%). Heel pain, tendonitis and plantar pain were noted in 19.67, 4.92 and 3.28% respectively. Most patients had lumbosacral and thoracic spine involvements, and only 49.18% showed involvement of the cervical spine. Bilateral sacroiliitis was noted in 98.36%. Uveitis was evident in 11.47% while evidence of aortic insufficiency was noted in 3.28%. An association with HLA-B27 was encountered in 91.07% of all cases. In general, the clinical features of AS in Thai patients are similar to those reported elsewhere, but an association with inflammatory bowel disease and Behcet's disease are notably absent.     

Effect of Spa therapy in Tiberias on patients with ankylosing spondylitis

Summary Fourteen patients with ankylosing spondylitis (AS) were treated in a pilot study for two weeks at a Tiberias spa with a combination of hot mineral water baths and mud packs. A significant improvement was noticed in morning stiffness, finger to floor distance and the overall well-being assessment both by the patient and the physician. A significant reduction in the use of analgesics and NSAIDs was also noted in most of the patients. Improvement in all parameters began after one week of treatment and was still present at three months.Tiberian Spa.     

Ankylosing spondylitis and sarcoidosis —Coincidence or association? Case report and review of the literature

Summary We report a 25-year-old woman presenting with sarcoidosis and bilateral sacroiliitis. Her sarcoidosis related symptoms (malaise, cough and dyspnoea) improved dramatically under treatment with steroids but severe back pain persisted. Only seven similar cases have been described over the last 40 years and the question of a possible association between the two diseases has been raised. However, prevalence data from the literature and the apparent lack of genetic links are better arguments for coincidence than for association.     

Profile of ankylosing spondylitis in Saudi Arabia

Summary This study describes the profile of ankylosing spondylitis as seen at the King Khalid University Hospital, Riyadh, Saudi Arabia over a period of 4 years. Fifteen cases were accumulated, eleven males and four females (M:F ratio 2.75:1). Thirteen patients were of Arab origin. The mean age of onset was 23.4 years, and all patients but one had a subacute onset. A positive family history was elicited in two patients (13%) and HLA B27 was positive in eight out of twelve patients (67%). Symmetrical radiographic sacroiilitis was present in all fifteen patients, radiographic spondylitis in eleven (73%), enthesitis in nine (60%) while peripheral joints were affected in five (33%). Conjunctivitis and uveitis were seen in 2 (13%) and 1 (7%) respectively. Most patients were in ARA functional Class I and II.     

Psychosocial factors and self-help in ankylosing spondylitis patients

Summary The purpose of this research was to investigate psychological factors associated with ankylosing spondylitis (AS), focusing on possible differences between members and nonmembers of self-help groups for people with this form of chronic disease. Analysis of health locus of control beliefs along 3 dimensions: internality powerful others and chance, showed that members of National Ankylosing Spondylitis Society (NASS) self-help groups placed significantly less reliance on powerful others for control of health than did nonmembers. This pattern of beliefs may be related to the nature of AS, which is incurable, progressive, unpredictable and difficult to diagnose. It may therefore appear to the patient that health care professionals have little to offer them. People who join a self-help group may also feel less reliant on medical personnel to control their health. Group members also differed from nonmembers in terms of belief in the value of exercise for AS, frequency of exercise, tendency to seek information about the disorder and perceived social support. A combination of psychosocial and medical variables discriminated between members and nonmembers at a rate of 71.9% accuracy. Results indicate that NASS self-help group members appear to comply more with exercise treatment and also receive a valuable source of social support from fellow members. This investigation demonstrates the utility of including psychosocial variables in the study of chronic disease.     

Serum secretory immunoglobulins in ankylosing spondylitis

Summary Humoral mucosal immunity may be implicated in pathophysiology of ankylosing spondylitis (AS). The aim of the study was to evaluate serum levels of IgA, IgM and secretory IgA (sIgA), secretory IgM (sIgM) as well as free secretory component (FSC) in patients with AS compared to controls and rheumatoid arthritis (RA) patients.Levels of sIgA, sIgM and FSC were measured with a specific ELISA in 37 AS patients, 45 controls and 27 RA. The results were as follows: Serum levels of IgA were higher in AS vs controls and in RA vs controls (p=0.01). Levels of sIgA were higher in AS vs controls (p=0.01), but higher in RA vs AS (p=10^–4). There was no difference of sIgM in AS vs controls, FSC levels were higher in AS vs controls, and higher in AS patients with elevated CRP.In view of elevated FSC, this increase of sIgA in AS may have been due to excessive production of mucosal IgA after bacterial stimulation according to the current hypothesis of the disease.     

Coexisting ankylosing spondylitis and Paget's disease

Summary The case of a 59-year-old man with definite HLA B27 negative ankylosing spondylitis (AS) and Paget's disease involving the skull, the right side of the pelvis and the proximal femur is reported. Fifteen cases with this coexistence have previously been described. Some of these, however, are patients with Paget's disease mimicking AS. It is emphasized again that attention must be paid to diagnosing AS in patients suffering from Paget's disease.     

Distribution of HLA-B*27 Alleles in Pa-tients with Ankylosing Spondylitis in Iran

Background: HLA-B*27 is strongly associated with ankylosing spondylitis (AS). It represents a family of alleles that differ among ethnic groups. Objective: The aim of this study was to determine the distribution of HLA-B*27 alleles in AS patients and healthy controls in Isfahan (Iran). Methods: Sixty AS patients and 430 healthy blood donors were selected. All subjects were HLA-B*27 positive by flow cytometry. HLAB* 27 subtypes were determined by PCR-SSP. Results: Forty patients (66.7%) and 17 controls (3.95%) were HLA-B*27 positive. Subtypes detected by PCR-SSP were B*2705, B*2702, B*2704 and B*2707. One patient was B*2702/B*2710. No significant difference was found in the distribution of these alleles between AS patients and controls. Conclusion: Although Caucasian subtypes are predominant among Iranians, this population is characterized by a combination of both specific Caucasian and Oriental subtypes. However such results should be interpreted carefully because of the small sample size in our investigation and definitive conclusion awaits more ethnicgroup studies.     

汕头地区15年强直性脊柱炎的临床分析

目的 了解本地区强直性脊柱炎（ＡＳ）的临床特点,提高诊治水平。方法 回顾性分析１９８３～１９９７年３７０例专门诊诊治的ＡＳ病人的一般临床资料、治疗及随访结果。结果 ９４％的病例隐匿发病。腰痛、外周关节炎、“４”字试验阳性、骶骼关节压痛和腰椎压痛为常见症状和体征。骶骼关节受累程度、髋关节和脊柱受累均与病程有关;儿童ＡＳ髋关节受累与病程关系不大;也有病程１６年但骶骼关节炎仍为Ⅱ级者。治疗头２年症状、体     

Bone mineral density in ankylosing spondylitis

Summary Vertebral osteoporosis is a well-recognized feature of ankylosing spondylitis (AS) and also the vertebral compression fractures due to osteoporosis are a common but frequently unrecognized complication of AS. Both may contribute to the pathogenesis of spinal deformity and back pain. The aim of this study was to measure vertebral and femoral neck bone mass in patients with AS by dual photon absorptiometry, to determine the prevalence of compression fractures and to examine the relationship between bone density and disease severity. We found that the bone mass was diminished in the lumbar spine in moderate AS versus mild forms but the patients with advanced disease had the highest BMD values. Examination of spinal radiographs revealed compression and biconcave fractures in 9 (40.9%) cases. Neither the duration of the disease and the degree of sacroiliitis, nor the disease activity assessed by laboratory and clinical parameters was found to significantly affect the results.