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

Present diagnostic criteria for ankylosing spondylitis (AS) lean heavily on the x-ray examination, but there is much dispute as to its efficacy, especially in mild or early cases. Determinations of the HLA B27 histocompatibility antigen appear to define the population at risk far better than any other means. Of 31 patients who had the HLA B27 antigen, all had negative latex fixation tests and axial polyarthritic complaints (seronegative spondyloarthropathy or rheumatoid variant). Three had Reiter's syndrome and one had ulcerative colitis. Of the remaining 27 patients, nine had definite AS, 11 had probable AS, and seven had possible AS. Eleven of the 27 underwent at least one invasive spinal procedure (myelogram, laminectomy, fusion, facet denervation) before a diagnosis of AS was made.
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PMID:The role of HLA B27 in the diagnosis and management of low-back pain and sciatica. 14 13

Histocompatibility typing has assumed an increasingly important role as a clinical and research tool in rheumatic diseases. The HLA antigens which are serologically defined (A and B series) are being used most extensively for clinical work, but the role of other immunologic determinants in the HLA complex is being evaluated. These include D-locus (MLC) determinants, several complement components, and immune response genes which have been well characterized in the mouse, but not in man. The products of the major histocompatibility complex are inherited in a simple Mendelian fashion as a series of co-dominant alleles. Large population studies have characterized the frequencies of various alleles, and family studies have allowed tentative mapping of the various loci within the complex on the sixth chromosome in man. A number of diseases which are considered to be autoimmune in nature are now known to be associated with specific HLA antigens. Of these disease associations, the strongest and best studied are the seronegative spondyloarthropathies which are highly associated with the B27 antigen. Included in this group are ankylosing spondylitis, Reiter's syndrome, psoriatic arthropathy, colitic arthropathy, Yersinia arthritis and a small group of juvenile rheumatoid arthritis patients with features of ankylosing spondylitis. The clinical application of tissue typing or B27 testing is most helpful in regard to difficult diagnostic problems in patients with early or atypical seronegative spondyloarthropathy. Its value as an indicator of prognosis, and its value in counselling family members is not well established. There are many interesting hypotheses regarding pathogenetic mechanisms of these rheumatic diseases based on susceptibility factors related to the major histocompatibility complex. An abnormal immune response gene within the complex is probably a key feature of the mechanism, but the exact details are little more than speculative at this point.
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PMID:The histocompatibility complex and rheumatic diseases. 30 Aug 26

Among the rheumatic diseases, non so clearly illustrates the relations between host and environmental factors as the seronegative spondyloarthropathy group of disorders. The strongest association is with the histocompatibility antigen HLA-B27, which accounts for a striking susceptibility to these diseases and is present in over 90% of individuals with idiopathic ankylosing spondylitis. Next in importance appears to be a difference in sex penetrance with males predominating in all categories. The most dramatic sex relationship is with postvenereal Reiter's syndrome which has a male-to-female ratio of nearly 50:1. Another potent host factor is age, with increased predisposition to onset at puberty and young adulthood in HLA-B27-positive patients. Environmental or possibly infectious agent influence are most apparent in Reiter's syndrome, where the antecedent circumstances of venereal contact and bacillary dysentery are frequent precipitating events. Secondary forms of peripheral arthritis, radiographic sacroiliitis, and ankylosing spondylitis frequently occur in psoriasis and inflammatory bowel disease; in the case of peripheral arthritis, there is no or a significantly reduced association with HLA-B27 compared to AS or RS. Secondary factor seem to be contributing to spondyloarthropathy in these disorders. These iterrelations emphasize the powerful effects of host characteristics on the type of rheumatic disease syndrome acquired and provide superb opportunities for more precise understanding of disease pathogenesis and ultimate control through the integration of epidemiologic, clinical, and laboratory research.
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PMID:A new look at the epidemiology of ankylosing spondylitis and related syndromes. 38 16

Most chronic arthritis in childhood is seronegative. Within "JRA" several distinct subgroups exist: one of these (pauciarticular disease type II) affects predominantly boys more than 8 years of age. It is clearly associated with sacroiliitis, HLA-B27, family history of spondyloarthropathy, and subsequent ankylosing spondylitis in an as yet underfined percentage of patients. This type of disease is probably classified appropriately with the spondyloarthropathies, although patients often may fulfill diagnostic criteria for "JRA" in the first years of their disease, and accounts for about 15% of "JRA." The other JRA subgroups do not appear to have features of seronegative spondyloarthropathy. Reiter's syndrome and psoriatic arthritis exist in children, but appear to be rare. The arthritis of inflammatory bowel disease in childhood resembles that in adulthood. The recognition of spondyloarthropathy in children, particularly the sizable group of patients with "JRA" pauciarticular disease type II, is of practical importance to permit proper therapy, follow-up and prevention of deformity.
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PMID:The seronegative spondyloarthropathies of childhood. 50 39

Many autoimmune diseases show a significant association with one or two second segregant series histocompatibility antigens. These associations are of great scientific interest, since they support the concept of HL-A-linked immune-response genes governing specific disease susceptibility. However, with one major exception, the association of HL-A antigens with diseases is not striking enough to provide a worthwhile diagnostic test. The exception is the extraordinarily high incidence of HLA B27 in patients with seronegative spondyloarthropathy best typified by ankylosing spondylitis (AS) and Reiter's disease (RD). In patients with these rheumatic syndromes, the antigen is present in more than 90% of cases compared to an incidence of approximately 6% in normal Caucasians and 4% in black Afro-Americans. The vast majority of rheumatic diseases are readily diagnosable on the basis of a history, physical examination and careful radiographic survey. This applies to most patients with a seronegative spondyloarthropathy, especially when the disease presents as a typical and fully formed clinical syndrome characterized as AS or RD. Sometimes the initial clinical nature may be atypical and only long-term follow-up of the patient will reveal an evolution toward the typical syndrome. In these situations, the correct diagnosis is reinforced by detecting the presence of HLA B27 on the patient's cells. Examination of the patient's family often reveals a high incidence of similar clinical syndromes, nearly always associated with the presence of the antigen. Since tissue typing at the moment is an expensive and relatively unavailable laboratory technic, its widespread and indiscriminatory use as a diagnostic test cannot be encouraged. However, in the clinical settings outlined above, tissue typing provides an invaluable diagnostic test. Presently, the combination of a negative test for rheumatoid factor and a positive test for HLA B27 is one of the strongest diagnostic laboratory profiles available to the physician when faced with a patient with early or atypical rheumatic disease. Aside from the purely clinical setting, the most exciting aspect of the association between these diseases and a specific cell surface antigen lies in the hope that we have a clue to the pathogenesis of a group of common rheumatic disorders. If the cause or causes of spondyloarthropathy can one day be found, the detection of HLA B27 may provide a useful public health measure facilitating preventive medicine. Even now, the detection of susceptible subjects within a family or a population will open the way for early diagnosis and treatment.
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PMID:HL-A antigens in clinical medicine. 108 97

Sulphasalazine has been shown to have an effect in patients with spondyloarthropathies, but the clinical indication for its use is controversial and its long term effect has not yet been evaluated. Treatment with sulphasalazine was analysed retrospectively in a group of 372 patients with a wide range of spondyloarthropathies to determine subsets of patients showing differential effects of the drug. One hundred and one patients received sulphasalazine at a mean daily dose of 2 g (ankylosing spondylitis, 54 patients; psoriatic arthritis, 21 patients; reactive arthritis, four patients; arthritis related to inflammatory bowel disease, six patients; undifferentiated spondyloarthropathy, 16 patients). A comparison between treated and untreated patients suggests that only patients with active and severe disease were treated whatever the precise diagnosis or the amount of axial disease in the spondyloarthropathy. After six months of treatment improvement was noted in 59 patients unrelated to their subgroup or amount of axial disease. After a mean follow up of 20 months, 37 patients were still receiving treatment, 33 had discontinued the drug because of inefficacy, 14 because of side effects, six because of remission of the disease, and 11 for other reasons. Comparison between the beginning and end of treatment showed a statistically significant decrease in morning stiffness, erythrocyte sedimentation rate, and daily dose of non-steroidal anti-inflammatory drugs (NSAIDs). It is concluded that: (a) a low percentage of patients with spondyloarthropathy have active disease requiring treatment with sulphasalazine despite the use of NSAIDs (27% in this study); (b) in this subgroup of patients sulphasalazine seems to be of clinically relevant benefit in 59%; and (c) this benefit does not seem to be correlated with either the precise diagnosis of spondyloarthropathy or the amount of axial disease.
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PMID:Evaluation of sulphasalazine in the treatment of spondyloarthropathies. 135 38

We report herein the association of primary pulmonary amyloidosis and ankylosing spondylitis. To our knowledge, this rare association has never been reported. This case reemphasizes that not all pulmonary complications that appear in the course of ankylosing spondylitis are related to the seronegative spondyloarthropathy. Primary pulmonary amyloidosis should be considered in patients with interstitial pulmonary disease.
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PMID:Pulmonary diffuse amyloidosis and ankylosing spondylitis. A rare association. 142 4

The association of HLA-B27 and seronegative spondyloarthropathies, especially ankylosing spondylitis has been known for almost two decades. The spontaneous development of spondyloarthropathy like joint disease in HLA-B27 transgenic rats verifies the suspicion that the HLA-B27 antigens are directly responsible for disease development. With the recently revealed crystal structure of HLA-B27 and understanding of the class I molecule in general, a new hypothesis can be formulated based on the assumption that the pathogenesis of these diseases is a subversion of the physiological function.
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PMID:The pathogenetic aspects of spondyloarthropathies from the point of view of HLA-B27. 143 78

A method has been developed for the objective assessment of vertebral 'squaring' based on quantitative morphometric analysis of vertebral 'concavity' in lateral radiographs of the lumbar spine. The reference range for vertebral concavity was defined as greater than 1.0-4.0 mm from measurements of 255 radiologically normal lumbar vertebrae in 51 patients with non-specific back pain. Evidence of vertebral squaring, as defined by concavity measurements of 1 mm or less, was found in 28% of vertebrae from 103 patients with ankylosing spondylitis and 8% of vertebrae from 10 patients with Reiter's syndrome. Assessment of vertebral squaring by the concavity measurement was more reproducible than subjective analysis in the diagnosis of vertebral squaring; in a subgroup of 30 patients with seronegative spondyloarthropathy, the interobserver agreement on the presence or absence of vertebral squaring as assessed by two independent clinicians was 84%, compared with 94% using the concavity measurement. Corresponding values for intraobserver agreement were 79% for subjective analysis and 84% for the concavity measurement. The vertebral concavity measurement is performed simply, rapidly (about three minutes for five lumbar vertebrae), and requires no special experience or equipment. As a result of this, the technique may be of value in the radiological diagnosis of ankylosing spondylitis and in assessing changes in vertebral squaring in individual patients with time.
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PMID:A new method for the radiological assessment of vertebral squaring in ankylosing spondylitis. 157 75

In order to establish how many children with seronegative spondyloarthropathy (SpA) starting with peripheral arthritis and/or enthesitis will develop ankylosing spondylitis (AS), 13 consecutive Caucasian pediatric patients, (11 with the seronegative enthesopathy and arthropathy (SEA) syndrome and 2 with isolated B27 associated peripheral arthritis or enthesitis at entry), were followed prospectively with no loss for more than 5 years. Sacroiliac joint plain films obtained at the last visit were mixed with those of 14 control subjects and read blindly. The course of SpA was self-limiting in 6 patients and recurrent in the other 7. Six patients had episodes of inflammatory cervical and/or lumbar pain during followup. However, none showed any limitation of spinal movement in the asymptomatic periods. Only one patient (9.1%) of 11 with the SEA syndrome showed bilateral sacroiliitis and met New York criteria for AS after 5 years of disease. Our results suggest that the proportion of Caucasian children with the SEA syndrome developing AS is much lower than the 75% found in a similar study on Mexican children. Lack of evaluation of all patients after 5 years, the reading of pelvic plain films without reducing observer error, and the male predominance in the Mexican study, probably in addition to ethnic or environmental factors, may account for differences.
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PMID:Low frequency of axial involvement in Caucasian pediatric patients with seronegative enthesopathy and arthropathy syndrome after 5 years of disease. 157 64


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