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Query: UNIPROT:P01889 (ankylosing spondylitis)
 5,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Spondylarthropathies consist of several disorders: reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, a subgroup of juvenile chronic arthritis, and ankylosing spondylitis. Their clinical presentation may consist in the following inter-related features: axial involvement, peripheral articular involvement, enthesiopathic lesions, extra-articular disease. The monitoring of these diseases is related more to their clinical presentation than to the precise diagnosis. Modalities for monitoring peripheral arthritis are similar to those of rheumatoid arthritis (essentially based on the number of tender and swollen joints). The modalities of the monitoring of extra-articular features (uveitis, psoriasis,...) are specific to these clinical features and can be categorized in 2 ways: the first one consists in considering the occurrence of the episodes (for example, number of acute anterior uveitis per year), the second one consists in the evaluation of the severity of the clinical features (for example the area of psoriatic skin lesions). Numerous tools have been proposed to evaluate the axial involvement of the disease. The international rheumatologic community (ILAR for International League Against Rheumatism) via specific task force (ASAS for Assessment in Ankylosing Spondylitis) tried to standardize the medical language (at least in clinical research studies) by giving recommendations to evaluate specific domains and within each domain specific tools. Currently, it is generally agreed that pain and functional impairment are the two main domains to consider. For each of these domains, different tools have been proposed (for example the ASFI: Ankylosing Spondylitis Functional Index and the BASFI: Bath Ankylosing Functional Index are both tools proposed to evaluate the functional impairment). The domain "range of motion" is probably one of the most important for long term outcome in clinical research studies and for facilitating the orthopedic indications in daily practice. Finally, radiological tools permitting the evaluation of the structural damage of the disease are available. They take into account the presence and/or the severity of hip and sacroiliac involvement and also the extent of the spinal syndesmophytes. Longitudinal studies are required to evaluate their clinical relevance.
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PMID:[Follow-up of the patient with spondyloarthropathy]. 1149 May 37

The observation that anti-tumor necrosis factor (anti-TNF) therapies dramatically reduce joint pain and inflammation and retard radiographic progression in rheumatoid arthritis (RA) has created a considerable amount of enthusiasm among rheumatologists and has set new treatment standards for patients with inflammatory joint disease. A central question that has emerged is whether these agents are effective in treating the seronegative spondyloarthropathies (SpA). A related question is whether second-line agents such as methotrexate (MTX) can improve axial inflammation and functional measures if administered early in disease. The SpA are a cluster of inflammatory arthridites encompassing ankylosing spondylitis (AS), psoriatic arthritis (PsA), Reiter's syndrome/reactive arthritis (ReA), and the arthritis associated with inflammatory bowel disease. These disorders share similar clinical and immunogenetic features including axial arthritis and enthesopathy, a general predilection for males and patients positive for the MHC class I alleles, the absence of rheumatoid factor, and association with infections of the intestinal and genitourinary tracts. Reclassification of SpA based on axial or peripheral involvement may be more relevant from a pathophysiologic and therapeutic perspective than the current stratification, given the strong association between axial disease and the HLAB27 allele and the relative resistance of axial disease to conventional anti-inflammatory therapy.
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PMID:Recent advances in the treatment of the seronegative spondyloarthropathies. 1156 71

Spondyloarthropathies are important and common inflammatory arthropathies that occur in approximately 2% of the population. They are often underrecognized. The diagnosis features the presence of asymmetrical, predominately lower limb arthritis and/or inflammatory back pain. The spondyloarthropathies can be subdivided into several disease subcategories, including ankylosing spondylitis, Reiter's/reactive arthritis, psoriatic arthritis, inflammatory bowel disease-associated arthritis and a large group of undifferentiated spondyloarthritis. The interactions between infectious agents and the individual's genetic background are important aetiological factors. Therapies for these conditions include physical therapy, non-steroidal anti-inflammatories and disease-modifying drugs.
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PMID:Spondyloarthropathies: an overview. 1178 74

Approximately one third of all patients with Crohn's disease and ulcerative colitis suffer from extra-intestinal manifestations of their inflammatory bowel disease. Most commonly those symptoms occur simultaneously with the CED symptoms; they can, however, either precede them or appear later on in the course of the disease. The most frequent extra-intestinal symptoms are arthralgias of peripheral joints and spine, which are usually bland and self-limiting, while ankylosing spondylitis and erosive arthritides are rare. Skin lesion and eye affections can also parallel the bowel condition, but occasionally they precede intestinal manifestations and can be a first diagnostic clue. In addition, different extra-intestinal symptoms tend to simultaneously co-occur more frequently in some patients with CED, while others are not affected at all. Immunogenetic parameters play a role for the manifestations of the pathologic immune response both in the gut and in the musculo-skeletal systems, as indicated by associations with MHC class I alleles. Enteropathic microorganisms are also thought to be involved in the pathogenetic mechanisms.
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PMID:[Extra-intestinal Manifestations of chronic inflammatory Bowel diseases]. 1193 Mar

Arthritis occurred in 23 of 136 (17 per cent) children and teenagers with inflammatory bowel disease, in 18 of 86 (21 per cent) patients with ulcerative colitis, and 5 of 50 (10 per cent) with granulomatous bowel disease. Eighteen children had peripheral arthritis which characteristically affected only a few large joints and was of brief duration and benign outcome. Five boys had spondylitis which was progressive and inseparable clinically from ankylosing spondylitis. Occurrence of joint manifestations was not associated with severity of bowel disease. Anemia and growth retardation occurred frequently. Mucocutaneous lesions were associated with peripheral arthritis but not with spondylitis. No patient had iridocyclitis. The possibility of bowel disease should be considered in children presenting with arthritis, particularly if gastrointestinal complaints, mucocutaneous lesions, anemia, or growth retardation are associated with pauciarticular arthritis. Peripheral arthritis is benign and regresses with improvement of underlying bowel disease but spondylitis is progressive and requires recognition and management for prevention of deformity.
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PMID:Arthritis associated with inflammatory bowel disease in children. 1211 46

The distribution of B27 alleles (B*2701-23) was characterized by PCR-SSP in ankylosing spondylitis and related spondyloarthropathies (SpA) in a sample of B27 positive patients from northern Spain. Six B27 alleles were identified: B*2705,02,03,07,08 and B*2713. B*2705 and 02 were the most common alleles in the SpA studied: ankylosing spondylitis (AS) (n = 89), reactive arthritis (ReA) (n = 11), psoriatic arthritis (PsA) (n = 29), and inflammatory bowel disease (IBD) (n = 21). B*2707 and B*2708 were found in PsA patients and B*2703 in one patient with IBD. B*2713 was identified in a healthy control family. B*2713 has not been reported to be represented in either ethnic group. Thus, this population shows higher levels of B27 diversity than other Caucasian groups.
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PMID:High variability of HLA-B27 alleles in ankylosing spondylitis and related spondyloarthropathies in the population of northern Spain. 1212 75

The conventional approach to treatment of patients with spondyloarthritis (SpA), particularly ankylosing spondylitis (AS), has serious limitations, adding a sense of urgency to the evaluation of new treatments for these rheumatic disorders. Tumour necrosis factor alpha (TNFalpha) is a cytokine that has been shown to mediate inflammatory and regulatory activities in SpA and other immune mediated diseases, including other arthritides and inflammatory bowel disease. Positive results have been reported in several international open label and randomised controlled trials of infliximab and etanercept, the two main biological agents targeting TNFalpha, which have included approximately 300 patients with SpA. Specifically, TNFalpha-directed therapy resulted in significant improvements in disease activity, function, and quality of life in these patients, most of whom had AS and received infliximab. Preliminary evidence from open label, long term extension trials suggests clinical benefit with continued use. Serious side effects were rare and consistent with experience from patient groups receiving infliximab or etanercept treatment for inflammatory bowel disease or rheumatoid arthritis. Together, these findings herald an age of more effective treatment of patients with AS with anti-TNFalpha and other emerging biological agents.
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PMID:Anti-tumour necrosis factor alpha therapy for ankylosing spondylitis: international experience. 1238 11

Spondyloarthropathies (SpA) are a group of related disorders with common clinical and genetic characteristics. The prototype disease in this group is ankylosing spondylitis; other entities include reactive arthritis, psoriatic arthritis, and arthritis in patients with inflammatory bowel disease. Over recent years, there has been a special interest in the relation between spondylitis/synovitis and gut inflammation in patients with SpA. Two thirds of patients with undifferentiated SpA show histologic signs of gut inflammation, and a fraction of these patients go on to develop clinically overt Crohn's disease. In this review, the authors will focus on 1) the growing evidence that has been provided that gut inflammation in SpA is immunologically related to Crohn's disease, based on the molecular characterization of the inflammation (lymphocyte homing markers and ligands, T cell cytokines, macrophage markers, and serology); and 2) on the therapeutic implications resulting from this concept. The recent introduction and positioning of anti-tumor necrosis factor-alpha therapy in patients with ankylosing spondylitis and other types of SpA is, in large part, based on this concept.
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PMID:Gut inflammation and spondyloarthropathies. 1242 69

Seronegative spondyloarthropathies are characterized by bilateral or unilateral sacroiliitis, spondylitis, peripheral arthritides or extraarticular manifestations. The spondyloarthropathies are associated with a positive HLA-B27 status. Genetic factors, repetitive biomechanical stress and the immune response to bacterial products lead to the inflammatory changes at typical anatomical sites. Diseases classified as spondyloarthropathies include ankylosing spondylitis, reactive arthritis, psoriatic arthritis, juvenile spondyloarthropathy and inflammatory bowel disease associated with spondylitis. The SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome is also considered a member of the spondyloarthropathy family. An otherwise unclassified HLA-B27-linked peripheral arthritis is often considered an undifferentiated spondyloarthropathy. Treatment consists of physical therapy including patient education, non-steroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs.
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PMID:[Seronegative spondyloarthropathies]. 1242 38

There is a paucity of randomized, controlled therapy studies of the extraintestinal manifestations of inflammatory bowel disease (IBD). Most current therapeutic approaches are empiric or based on approaches to therapy in other settings. In the past year anecdotal evidence has emerged for the use of therapies that neutralize tumor necrosis factor-a in both ankylosing spondylitis and the dermatologic extraintestinal manifestations. Topical tacrolimus has also emerged as a potentially useful therapy for dermatologic manifestations. Finally, patients with IBD occasionally become transplant recipients. One study reported worsening IBD after orthotopic liver transplantation for primary sclerosing cholangitis, and another reported the benefit of renal transplantation in amyloidosis-induced renal failure.
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PMID:Treatment of the extraintestinal manifestations of inflammatory bowel disease. 1244 Oct 42


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