Orofacial manifestations in patients with inflammatory rheumatic diseases

The main orofacial manifestation of the inflammatory rheumatic diseases is that of Sjögren's syndrome. In addition, there is a constellation of orofacial manifestations of the inflammatory rheumatic diseases, many of which are extra-articular with some constituting presenting signs of the underlying rheumatic disease. This review will discuss the orofacial manifestations in a variety of connective tissue diseases and will also allude to the oral adverse drug reactions that may occur as a consequence of therapy.     

Aspects of the spectrum, prevalence and disease susceptibility determinants of Reiter's syndrome and related disorders associated with HIV infection

Summary Arthrocutaneous disorders including Reiter's syndrome, psoriasiform rashes, and other forms of chronic arthritis and enthesopathy, such as psoriatic arthritis, occur with an increased prevalence in the setting of HIV infection. Herein we describe the spectrum and prevalence of musculoskeletal and allied skin disorders as they occur in the setting of HIV infection. The role of genetic susceptibility in the development of these disorders is addressed. Based on the frequency of infectious agents capable of triggering reactive arthritis and the presence of HLA-B27 in 71% of these individuals, it is suggested that the disorder strongly resembles Reiter's syndrome as it occurs in the not HIV-infected group. Preliminary evidence indicates an enhanced penetrance for susceptibility among HLA-B27 individuals. In contrast, among HIV-infected patients with psoriasiform lesions there was no statistically significant association (P<0.05) between the presence of psoriasiform rash and the HLA alleles Cw6, B7, B17, Bw16, or Bw57 when compared with HIV-infected controls. These findings suggest that among HIV-infected individuals the development of Reiter's syndrome involves an immune recognition event primarily dependent upon HLA-B27 molecules in which an unknown antigen in the context of HLA-B27 is presented to CD8 lineage suppressor/cytotoxic cells. In contrast, the pathogenesis of psoriasiform lesions in HIV patients, despite their similarity to certain lesions in Reiter's syndrome, proceeds by distinct pathways that do not involve events influenced by specific polymorphic class I molecules.     

误诊为脊柱关节病的下背痛患者24例临床分析

目的通过对被误诊为脊柱关节病的24例下背痛患者的临床资料分析,探讨误诊原因,进而提高脊柱关节病诊断的符合率.方法采用访视追踪、复查观察及病历资料查询等方法对被误诊为脊柱关节病的24例病例进行回顾性分析.结果误诊的疾病种类主要为恶性肿瘤4例（腹膜后脂肪肉瘤、晚期胃癌、卵巢乳头状瘤和急性淋巴细胞白血病各1例）、良性肿瘤6例（甲状旁腺腺瘤并甲状旁腺功能亢进症2例,椎管内室管膜瘤、椎管内脂肪瘤、椎管内神经鞘瘤及骶管内囊肿各1例）及14例其他疾病（致密性骨炎和纤维肌痛综合征各3例,弥漫性特发性骨肥厚症2例,肝豆状核变性、腰椎间盘突出症、范可尼综合征、先天性脊柱侧弯、褐黄病和低磷酸盐血症性脊柱病各1例）.10例肿瘤中除2例甲状旁腺腺瘤和1例骶管囊肿外,均表现为持续性下背痛,不伴晨僵,经休息或活动后均不能有效缓解,应用多种非甾类抗炎药无效.尽管有11例患者符合Calin定义的炎性下背痛,但仅有2例患者符合欧洲脊柱关节病研究组（ESSG）关于脊柱关节病的分类标准.结论熟练掌握脊柱关节病的ESSG分类标准,并了解下背痛的鉴别诊断方法可减少对脊柱关节病的误诊.     

Criterios de cribado de enfermedad inflamatoria intestinal y espondiloartritis para derivación de pacientes entre Reumatología y Gastroenterología

Objective

To define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for referring them to the rheumatology or gastroenterology service.

Ankylosing spondylitis and undifferentiated spondyloarthritis in Kuwait: a comparison between Arabs and South Asians

The objectives of this study were to describe and compare the clinical characteristics of ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA) in Middle East Arab (MEA) and South Asian (SA) patients diagnosed in our unit. Fifty-eight consecutive patients diagnosed with SpA were studied after classifying them into MEA and SA. They were further classified as per disease diagnosis. Excluding three patients with miscellaneous ethnicity, there were 29 MEA and 26 SA patients. Seventy-two percent of MEA patients were males (vs 92% of SA patients). Of the 29 patients with MEA ethnicity, 17 had AS and 9 had USpA. Of the 26 patients with SA ethnicity, 10 had AS and 14 had USpA. Fifty-nine percent of MEA patients had AS (vs 39% of SA patients). Mean age at onset in AS patients was similar in the two ethnic groups. However, in patients with USpA, mean age at onset was somewhat lower at 21.8 years in the MEA group compared with 29.4 years in the SA group. Family history in first-degree relatives was significantly more common in MEA patients. Weight loss, inflammatory spinal pain, gluteal pain, and enthesopathy were equally common in both ethnic groups. Knee, ankle, and metatarsophalangeal joint involvement was less common in MEA patients. There were no significant differences in the occurrence of syndesmophytes, bamboo spine, and sacroiliitis in the two ethnic groups. HLA-B27 positivity rates in MEA patients were 87% for AS and 67% for USpA compared to 75 and 71%, respectively, in SA patients. It is concluded that some significant new findings have arisen from this study: the majority of MEA patients presented with AS, whereas the majority of SA patients had a picture of USpA. Family history was more common in MEA patients. Peripheral arthritis was less common in MEA patients. Worldwide, this is the first study to show that there are significant differences in the clinical expression of the various SpA in MEA patients compared to SA patients.     

Criterios de cribado de enfermedad inflamatoria intestinal y espondiloartritis para derivación de pacientes entre Reumatología y Gastroenterología

Objective

To define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for referring them to the rheumatology or gastroenterology service.

Polymorphsims of CTLA-4 Exon 1 +49, CTLA-4 Promoter –318 and Fas Promoter –670 in Spondyloarthropathies

The aim of the study was to investigate a possible association between the CTLA-4 exon 1 +49, CTLA-4 promoter –318 and Fas promoter –670 and spondyloarthropathies (SpA). Polymerase chain reaction of genomic DNA-restriction fragment length polymorphism was used to determine genotypes of the CTLA-4 exon 1 +49, CTLA-4 promoter –318 and Fas promoter –670 in 54 SpA patients, 84 healthy control subjects and 87 bronchial asthma patients as disease controls. There were no significant differences in the genotype and allele frequencies of the CTLA-4 exon 1, promoter and Fas promoter genes among SpA, asthma patients and controls. No significant differences were found in age at onset, sex, disease duration, history of enthesopathy, peripheral arthritis and uveitis, Schober test, chest expansion, white blood cell count, C-reactive protein and erythrocyte sedimentation rate among patients with SpA according to the CTLA-4 exon 1, CTLA-4 promoter and Fas promoter polymorphisms. We found no association between the polymorphisms of the CTLA-4 exon 1 +49, CTLA-4 promoter –318 and Fas promoter –670 genes and SpA. However, further studies are required to discover the possible contribution of the polymorphisms of the CTLA-4 and Fas to the pathogenesis of SpA. Received: 14 March 2001 / Accepted: 2 July 2001     

软骨寡聚基质蛋白在脊柱关节病患者血清中的水平及意义的研究

目的探讨血清软骨寡聚基质蛋白（COMP）水平与脊柱关节病（SpA）患者病情活动及骨破坏的相关性。方法采用酶联免疫吸附试验（ELISA）方法,检测38例SpA患者、18例正常人及10例注射用重组人Ⅱ型肿瘤坏死因子受体一抗体融合蛋白（商品名益赛普）治疗前后SpA患者血清COMP水平、血沉及C反应蛋白,并行骶髂关节CT分级．记录患者BAS、ASDAS评分及夜间脊柱痛视觉评分（VAS）,分析其与COMP的相关性。结果SpA患者组血清COMP水平为（30．835±8．539）ng／ml,明显高于正常对照组的（12．639±2．939）ng／ml（P〈0．01）;病情活动组血清COMP水平为（34．168±7．988）ng／ml．明显高于非活动组的（25．122±6．243）ng／ml（P=0．01）;治疗后SpA患者血清COMP水平为（17．670±7．199）ng／ml．较治疗前的（35．645±7．381）ng／ml明显下降（P〈0．01）。COMP水平与夜间脊柱痛VAS、ESR、CRP及骶髂关节CT分级正相关．与BSADAI、BSAFI、ASDAS—ESR、ASDAS—CRP正相关,与年龄、病程、BASMI及外周关节受累无显著相关。结论SpA患者血清COMP高水平存在提示病情活动,可能预示明显骨质破坏,血清COMP有可能成为判断SpA疾病活动性和疗效的指标。     

Clinico-radiological correlation of enthesitis in seronegative spondyloarthropathies (SNSA)

Summary The goal of this work was to evaluate clinico-radiological correlation of enthesitis in SNSA patients, selected for presenting at least one radiological enthesopathy. Out of 50 patients with SNSA, 40 were selected for having had at least one radiological enthesitis. In a cross-sectional study, 32 males and 8 females, whose mean age was 40.4 years and mean disease duration 13 years, were evaluated. Nineteen patients had ankylosing spondylitis, 15 psoriatic arthritis and 6 Reiter's syndrome. Sites evaluated were pelvis and lower limbs. Radiological enthesopathies were identified by the presence of calcifications, new bone formation and/or erosions in tendinous and ligamentous insertion sites, and clinical enthesitis due to pain or tenderness and/or swelling at such locations. The site most commonly involved radiologically was the sciatic tuberosity in 33/40 cases, followed by the calcaneus with 12/40 on its inferior and 11/40 on its posterior aspect. Fifteen patients (37%) presented clinical manifestations at tendinous insertion sites, but clinico-radiological correlation was found in only 4 (22%).We conclude that clinical and radiological manifestations correlate poorly in SNSA enthesitis, perhaps due to the wide diversity of developmental stages of the disease.Supported in part by Clinical Research Funds from Fundación Reumatológica Argentina Dr. Osvaldo García Morteo.