HLA-B27 Positive Patients Research Articles

Uveitis of spondyloarthritis in Indian subcontinent: a cross sectional study

Background: The seronegative spondyloarthritis (SpA) are known to have intimate association with ocular inflammatory disease. While anterior uveitis accounts for 50-92% of all cases of uveitis in the West, it ranges between 28 and 50% in the Asian countries. The aim of this study was to document the clinical profile of uveitis in patients with spondyloarthritis in the Indian subcontinent.Methods: In our hospital based cross sectional study, 166 patients fulfilling Assessment of SpondyloArthritis international Society’ (ASAS) criteria for spondyloarthritis (SpA) were evaluated for evidence and nature of uveitis, including by a slit lamp bio microscope. The characteristics of Uveitis were defined as per the SUN (Standardization of Uveitis Nomenclature) Working Group criteria. 84.3% (140) of the patients were male.Results: Ankylosing spondylitis was the commonest type of spondyloarthritis accounting for 69.3% patients. Evidence of past or present uveitis was found in 16.3% patients. Of the patients with uveitis 96.3% had anterior uveitis. 88.9% of the patients had redness of the eye, and 85.2% reported pain in the eye during an episode of uveitis. Mean duration of musculoskeletal symptoms prior to the diagnosis of SpA was 4.36 years. Of the 24 patients who could recall the course of uveitis 70.8% (17) had recurrent episodes. As a complication of uveitis 18.5% had cataract, and 14.8% had posterior synechiae. 78.3% patients were HLA-B27 positive. 19.2% of HLA-B27 positive patients had uveitis, whereas only 5.6% out of the 36 HLA-B27 negative patients had uveitis.Conclusions: The proportion of patients with uveitis in our study (16.3%) was considerably less than in other studies. The characteristics and profile of uveitis in our cohort of SpA patients from the Indian subcontinent were similar to those previously reported in literature.

Clinical study on efficacy of infliximab on severity and occurrence of acute anterior uveitis in HLA-B27

Aim: To study the efficacy of Infliximab on the severity and occurrence of Acute Anterior Uveitis in HLA B27 positive patients. Materials and Methods: This is a prospective observational study done on 30 patients with acute anterior uveitis who were HLA B27 positive presenting to Uvea and Retina Services at Regional Institute of Ophthalmology Government Ophthalmic Hospital, Chennai between April 2013 to May 2015. Of which 16 patients were on Infliximab therapy (3-5mg/kg) for Ankylosing Spondylitis, 6 patients were on Tablet Sulfasalazine for the articular symptoms of Ankylosing Spondylitis and 8 patients were not on any medication and were retrospectively diagnosed as HLA-B27 positive. A detailed history, systemic examination, ocular examination using Slit lamp, 90D biomicroscopy, blood investigations for HLA B27 and MRI Sacroiliac joint was done. Patients were started on topical corticosteroids and cycloplegics, the response noted and followed up for 3 months. Results: Severity of uveitis did not show any variation between groups that were on infliximab and sulfasalazine and those who were not on any treatment. Patients in the three groups responded dramatically well to topical corticosteroids and cycloplegics. Conclusion: Infliximab (3-5mg/kg) regime used for the control of symptoms of Ankylosing Spondylitis neither prevents the occurrence nor decreases the severity of Acute Anterior Uveitis in HLA-B27 patients. Further studies are needed to establish the safe and effective dosage of Infliximab to prevent the occurrences of Acute Anterior Uveitis in HLA B27 patients.

Choroidal thickness changes determined by EDI-OCT on acute anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis.

To evaluate the choroidal thickness on acute anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis. In this study, 32 eyes of 16 HLA-B27 positive AS patients with anterior uveitis and age-matched 19 eyes for control group were analyzed between January 2014 and April 2015. Assessment criteria were uveitis activity, visual acuity, flare existence, subfoveal choroidal thickness and central macular thickness measurements. The mean subfoveal choroidal thicknesses in affected eye group (Group 1), unaffected eye group (Group 2) and control group (Group 3) were 348.31±72.7, 301.12±49.2 and 318.0±74.3, respectively, in active periods. (p=0.04 between Group 1 and Group 2, p=0.234 between Group 1 and Group 3) The mean central macular thicknesses of Group 1, Group 2 and Group 3 were 268.50±16.5, 267.31±16.3 and 249.7±30.5, respectively, in active periods. (p=0.84 between Group 1 and Group 2, p=0.029 between Group 1 and Group 3). However, in convalescence period, the mean subfoveal choroidal thicknesses of Group 1, Group 2 and Group 3 were 322.40±48.5, 300.75±47.7 and 318.0±74.3, respectively. (p=0.22 between Group 1 and Group 2, p=0.854 between Group 1 and Group 3) The mean central macular thicknesses of Group 1, Group 2 and Group 3 were 269.75±21.9, 256.62±21.5 and 249.7±30.5, respectively. (p=0.09 between Group 1 and Group 2, p=0.03 between Group 1 and Group 3). In HLA-B27 positive ankylosing spondylitis patients with anterior uveitis, the choroidal thicknesses of the affected eyes were found as thicker than fellow unaffected one or control eyes in active period. The central macular thicknesses are not affected on both active and convalescent period.

Frequency of HLA-B27 in Patients With Conductive System Disturbance and Implanted Permanent Pacemaker in Iran

Introduction: HLA-B27 is considered as one of the causes of heart conductive disorders. We studied the frequency of HLA-B27 among Iranian patients who had undergone permanent pacemaker implantation. Methods: This descriptive and analytical study was performed among patients who underwent permanent pacemaker implantation. The questionnaire contains demographic data, underling diseases, and history of heart disease or heart surgery. The type of conductive heart disorder was mentioned there, too. We determined the regurgitation of aorta valve and its severity. Finally, HLA-B27 was accessed. All the data was entered in SPSS software and analyzed. Results: From a total of 103 patients entered in this study, only 6 (5.8%) were HLAB-27 positive. The disturbance of conductive heart disorders based on the HLA-B27 positive or negative patients was not statistically different. Patients with HLA-B27 mostly had regurgitation of the aorta valve. Conclusions: We concluded that the frequency of positive HLA-B27 genotype in patients with permanent pacemakers did not have any significant difference with the ones with negative HLA-B27 genotype. However; this genotype was associated with regurgitation of the aorta valve.

Magnetic Resonance Imaging of the Axial Skeleton in Patients With Spondyloarthritis: Distribution Pattern of Inflammatory and Structural Lesions.

Purpose:Spondyloarthritis is a chronic inflammatory disorder of the musculoskeletal system driven by systemic enthesitis and typically involving the axial skeleton, ie, the spine and the sacroiliac joints. The purpose of this study was to assess the distribution pattern of inflammatory and structural magnetic resonance imaging (MRI) findings in spondyloarthritis.Methods:Retrospective study of 193 patients with axial spondyloarthritis who received MRI of the spine and the sacroiliac joints. We quantitatively assessed inflammatory and structural lesions using established MRI-based scoring methods. The significance of the differences between gender, HLA-B27 status, and spine and sacroiliac involvement was determined.Results:In total, 174 patients (90.2%) showed a sacroiliac involvement and 120 patients (62.2%) a combined involvement of the sacroiliac joints and the spine. An isolated sacroiliac involvement was found in 54 patients (28.0%) and an isolated spine involvement in 19 patients (9.8%). The sacroiliac joint was significantly more involved in men than in women (P < .01), and men had significantly higher scores for structural lesions (P < .001). The subgroup of HLA-B27–positive patients showed a significantly higher percentage of sacroiliac involvement compared with HLA-B27–negative patients (P < .05).Conclusions:Spondyloarthritis is a systemic disorder predominantly involving the sacroiliac joints. However, the entire axial skeleton may be affected. In particular, HLA-B27–negative women show atypical manifestations without sacroiliac involvement. Magnetic resonance imaging in spondyloarthritis should cover the entire axial skeleton, ie, sacroiliac joints and the spine to meet the pathophysiology of this disorder and capture the true extent of inflammatory and structural lesions.

Prevalence and topographic distribution of spinal inflammation on MR imaging in patients recently diagnosed with axial spondyloarthritis.

The primary goal of this study was to determine the prevalence and topographic distribution of spinal lesions in lower thoracic and lumbar spine on magnetic resonance imaging (MRI) in patients with recently diagnosed with spondyloarthritis. The secondary goal was to identify variables associated with vertebral patterns consistent with spondyloarthritis on MRI. A total of 112 HLA-B27 positive patients with recently diagnosed spondyloarthritis were retrospectively included. There were 70 women and 42 men, with a mean age of 41 years±12 (SD) (range: 17-70years). Mean symptom duration was 1year (range: 0-7years). MRI examinations of sacroiliac joints and thoracolumbar spine were reviewed for the presence of bone marrow edema, chronic structural abnormalities, and vertebral patterns consistent with spondyloarthritis. Age, gender and disease duration of patients with vertebral patterns on MRI consistent with spondyloarthritis were compared with those without MRI signs of spondyloarthritis. Thirty-six patients (32.1%) showed spinal patterns of spondyloarthritis, including 16 patients (14.3%) with no associated inflammatory sacroiliitis. Posterior inflammatory lesions were present in 20.5% of patients. Posterior spinal inflammatory lesions were significantly associated with vertebral corner inflammatory lesions (P=0.03). There were no differences in age, sex or mean duration of symptoms between the two groups of patients. Spinal involvement is observed in 32.1% of HLA-B27 positive patients with recently diagnosed spondyloarthritis and is not associated with sacroiliitis in 14.3%. Age, gender or symptom duration are not associated with spinal involvement on MRI.

Clinical Correlation between HLA-B27 and Inflammatory Marker in Case of Ankylosing Spondylitis (AS)

Aims: The aim of the study is to establish the correlation among CRP(C reactive protein), ESR (erythrocyte sedimentation rate) and Rheumatoid factor in case of HLA-B27 positive and negative patients in comparison to healthy control. Materials and Methods: Eighty patients were selected for study in which 40 with AS 40 controls. The clinical and laboratory data including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and HLA-B27 of patients were recorded. Results: The mean age of 40 patients was 31.6 ± 9.77 years. HLA-B27 was positive in 48 patients (60%) and it was found that disease activity was significantly associated with serum concentrations of CRP and ESR. In contrast, in the HLA B27- patients concentrations of ESR were significantly associated with disease activity, but not the concentrations of CRP. Conclusion: These results indicates that the known difference between HLA B27 positive and HLA B27 negative AS and suggest that the different pathogenic mechanisms involve in the two forms of AS, and the geographic regions and also the age at which the illness begins is one of the important predictors for the functional and clinical status in the disease course in Indian population.

INTERLEUKIN 1A GENE POLYMORPHISMS IN ROMANIAN PATIENTS WITH SERONEGATIVE SPONDYLOARTHROPATHIES

Objective. The aim of this study was to investigate whether two IL1A gene polymorphisms, rs17561 and rs1800587, influence disease susceptibility for seronegative spondyloarthropathies (SpA) in Romanians. Subsequently, we analysed separately ankylosing spondylitis (AS) and psoriatic arthritis (PsA) subgroups in relation with the two IL1A gene variants. Methods. The study included 240 SpA patients (140 AS and 100 PsA patients) and 160 healthy controls. Real-time polymerase chain reaction (RT-PCR) was used to genotype the two single nucleotide polymorphisms (SNPs). Allele, genotype and haplotype frequencies of each SNP were compared between SpA patients and controls and also between AS and PsA cohorts and controls. The PLINK 1.9 software package was used to assess the potential associations; p values ≤ 0.05 were considered significant. Results. The minor allele T frequency for rs17561 polymorphism was similar in general SpA cohort (31.4%) compared with controls (32.8%), the statistical analyses confirming the lack of association (p=0.67). Almost identical results were found for rs1800587: minor allele T frequency was 29.1% in SpA patients and 29.7% in controls (p=0.85). The same pattern persisted for the separate analysis of HLA-B27 positive SpA patients or AS and PsA cases against controls. Conclusions. The IL1A gene polymorphisms (rs17561 and rs1800587) do not influence the disease predisposition for seronegative spondyloarthropathies in general, nor for ankylosing spondylitis and psoriatic arthritis in particular, in Romanians.

Diagnostic Delay in Ankylosing Spondylitis: Related Factors and Prognostic Outcomes.

This study aims to evaluate diagnostic delay, factors which are related to diagnostic delay, and the effect of diagnostic delay on prognostic outcomes in terms of spinal and hip mobility, functional status, disease activity, quality of life, cervical rotation, tragus to wall distance, and sacroiliitis severity in an Iranian population with ankylosing spondylitis (AS). One hundred and sixty three patients (129 males, 34 females; mean age 37.74±9.88 years; range 18 to 65 years) with AS who met modified New York 1984 criteria were enrolled consecutively in a cross sectional survey. The main outcome variable (diagnostic delay) was defined as the interval between appearance of first symptoms and correct diagnosis of AS. Enthesitis, negative human leukocyte antigen B27 (HLA- B27), and educational level were among the factors of which their relationship to diagnostic delay were evaluated. The prognostic outcomes were measured using Bath ankylosing spondylitis functional index, Bath ankylosing spondylitis disease activity index, AS quality of life, Bath ankylosing spondylitis metrology index, chest expansion, and radiographic sacroiliitis severity. Diagnostic delay was mean 7.88±7.17 years. Diagnostic delay was longer in patients with enthesitis (8.80±7.27) compared to patients without enthesitis (6.04±6.66) (p=0.007) and in HLA-B27 negative patients (10.10±7.44) compared to HLA-B27 positive patients (7.14±6.96) (p=0.013). Educational level was negatively correlated with diagnostic delay (p=0.002, r= -0.24). Diagnostic delay was correlated with Bath ankylosing spondylitis functional index (p=0.003, r=0.23), Bath ankylosing spondylitis disease activity index (p=0.026, r=0.18), AS quality of life (p=0.008, r=0.21), Bath ankylosing spondylitis metrology index (p<0.001, r=0.41), chest expansion (p<0.001, r= - 0.38), and sacroiliitis grading (p=0.042, r=0.16). Negative HLA-B27, enthesitis, and low educational level are factors which affect diagnostic delay in AS. Individuals with enthesitis or low educational level should be evaluated accurately without causing delay in diagnosis since longer delay may lead to poorer prognostic outcomes.

Ultrasonography Role in Evaluation of Achilles Tendon Enthesis in Reactive Arthritis Patients.

Reactive arthritis is an inflammatory joint disease which develops after 1-4 weeks following an enteral, genital or ORL infection, with a higher frequency in HLA-B27 positive patients. As a group feature, enthesitis is defined as inflammation in bone insertions of tendons, ligaments and muscular fascia. Aims: the main object of this study was to demonstrate the importance of musculoskeletal ultrasonography in Achilles tendon evaluation in patients with reactive arthritis. Patients and methods: we designed a transversal, retrospective study which included 15 patients diagnosed, based on ESSG criteria, with reactive arthritis (ReA), in Rheumatology Department, Emergency County Hospital. From those 15 patients, 9 were positive for a genital infection with Chlamydia trachomatis and 6 patients with enteral infection, 2 with Shigella, respectively 4 with Yersinia. Healthy control group included 15 patients, with no inflammatory joint diseases. After clinical examination, all patients and controls underwent ultrasound (US) evaluation for Achilles tendon changes, using an Esaote MyLab 25 machine, with a linear high frequency probe (10-18 MHz), using EULAR recommendations and OMERACT definitions for enthesitis, tendinitis and erosions. The cutoff value for the Achilles tendon thickness was 5.29mm, as described by Balint et al. Results: We examined 30 Achilles tendons in 15 patients, with a mean age of 35,2years±10,19 standard deviation (SD) and 30 tendons in 15 controls with a mean age of 35,8 years ±12,00 SD. In both groups sex prevalence showed more males than females (66,66% males in controls vs. 60,00% in patients group). We found a statistic significant higher ESR and CRP in patients group, compared to controls (24,86mm/h vs. 11,8mm/h; 18.90mg/dl vs. 6.22mg/dl). Most frequent finding in patients group was retrocalcaneal bursitis (56.66%), followed by tendon thickening (46.66%), compared to control group in which we found more frequently osteophytes (36.66%) and calcifications (23.33%). Tendon thickness was significantly higher in the patients group compared to control group 5.30mm±1.39SD vs. 4.42mm±0.77SD, p=0.008). When compared to clinical examination, US found at least one change in all patients (100% vs. 40.0%). Conclusions: A higher prevalence of retrocalcaneal bursitis and tendon thickening were found in reactive arthritis patients compared to control group. The US found more changes compared to clinical examination and manage to discriminate between the types of changes found more frequently in inflammatory conditions.

Cartilage collagen type II seromarker patterns in axial spondyloarthritis and psoriatic arthritis: associations with disease activity, smoking and HLA-B27.

The aim of the study was to assess the possible association between type II collagen turnover seromarkers and disease profile in patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA). Outpatients with axial SpA (n=110) or PsA (n=101) underwent clinical examination including disease activity measures and HLA-B27 typing. The procollagen IIA N-terminal peptide (PIIANP) and a matrix metalloproteinase-generated type II collagen fragment (C2M) were quantified in serum by ELISA. C2M was higher in SpA than in controls, 0.41 versus 0.36ng/ml (p=0.004), while PIIANP did not differ between patients and healthy subjects, 2252 versus 2142ng/ml (p=0.13). However, DMARD-naïve SpA patients had higher PIIANP, 2461ng/ml (p=0.01) and C2M, 0.44ng/ml (p=0.0007) levels than controls, and PIIANP correlated with CRP (ρ=0.34). C2M was lower in SpA smokers, 0.36ng/ml versus non-smokers, 0.43ng/ml (p=0.02), while PIIANP was higher in HLA-B27 positive, 2312ng/ml versus negative patients, 2021ng/ml (p=0.03). In PsA, PIIANP and C2M did not differ between patients and controls, but PIIANP was elevated in patients not receiving DMARDs, 2726ng/ml. In PsA, PIIANP and C2M did not differ according to smoking and HLA-B27. Cartilage degradation assessed by C2M is increased in SpA irrespective of treatment but not in PsA. Cartilage synthesis reflected by PIIANP is increased in untreated SpA and PsA. PIIANP correlates with CRP in SpA while not in PsA. In DMARD-naïve SpA but not in PsA, HLA-B27 positivity and smoking are associated with a chondro-proliferative metabolic pattern.

Diagnostic value of anti-MCV antibodies for ankylosing spondylitis

Objective To investigate the diagnostic value of anti-mutated citrullinated vimentin（anti-MCV） and anti-cyclic citrullinated peptide（anti-CCP） antibodies for ankylosing spondylitis (AS), and to establish a new diagnostic method of AS based on anti-citrullinated protein/peptide antibodies（ACPAs） detection. Methods Totally 121 AS patients(AS group), 97 rheumatoid arthritis（RA） patients(RA group)and 103 healthy people(control group) were enrolled for the detection of serum levels of anti-MCV and anti-CCP antibodies using ELISA method as a diagnostic test. HLA-B27 in AS patients was tested by flow cytometry, and RF-IgM in RA and AS patients was detected by immune rate nephelometry. Receiver operating characteristics (ROC) curve was used to analyze the diagnostic value and to determine the cut-off value. Anti-MCV and anti-CCP antibodies among each group were compared by Mann-Whitney U test, Chi-square test or Fisher′s exact test was used to compare positive rate. Results The anti-MCV levels in AS group ［11.60 (12.36-25.83) U/ml］were significantly higher than control group ［11.60(8.41-13.54）U/ml ］,U=2 413,P<0.001, while the levels of anti-CCP had no difference between the two groups ［AS group 6.22 （4.30-8.07）U/ml］, and control group ［6.01(3.77-7.58)U/ml］, respectively; U=5 421,P=0.094. The calculated area under the ROC curve of anti-MCV was 0.806,and 14.67 U/ml was the optimal cut-off value with sensitivity of 0.645 and specificity of 0.942. In both HLA-B27 positive and negative AS patients, anti-MCV antibodies levels and positive rate were significantly higher than control group using new cut-off value above （U=133.5, P=0.001; U=2 279.5,P<0.001). Sensitivity of the combination detection of anti-MCV and anti-CCP (MCV+CCP－) or RF-IgM (MCV+RF－) were 60.3% (73/121), 62.8% (76/121) and specificity were 89.7% (87/97), 90.7% (88/97) respectively in differential diagnosis of AS and RA, which were significantly higher than anti-MCV detection alone in specificity (16.5%,16/97). Conclusions Anti-MCV could be a new biomarker for the diagnosis of AS. With high sensitivity and specificity, anti-MCV has an equal diagnostic efficiency in HLA-B27 positive and negative AS patients using our new cut-off value. Additionally， the combination detection of anti-MCV and anti-CCP or RF-IgM could be an effective method for differential diagnosis of AS and RA.（Chin J Lab Med,2014,37: 455-458） Key words: Spondylitis,ankylosing; Peptides,cyclic; Vimentin; Mutation; Rheumatoid factor

THU0091 Differences in the Uveitis versus NON Uveitis Individuals with HLAB27 Positive Spondyloarthritis with Regards to Clinical Characteristics, Disease Activity and Function

BackgroundAnterior uveitis is an extra-articular manifestation of spondyloarthritis (SpA)ObjectivesTo analyze patients data and compare the main musculoskeletal problems as well as clinical characteristics (sacroilitis, enthesitis, psoriasis, night pain, well being),...

AB0735 Diagnostic Delay Worsens Mobility and Work Disability in Ankylosing Spondylitis

BackgroundDiagnostic delay (DD) in Ankylosing Spondylitis (AS) remains a challenge, averaging 8.6 years1. Chronic back pain comprises 2.6million GP consultations per year, of which 5% have AS2. Identifying this “needle...

AB0695 Cardiac Involvement in Ankylosing Spondylitis in A Tunisien Population

BackgroundCardiac involvement in ankylosing spondylitis is uncommon. We have tried through this study to analyze the cardiovascular events among 50 patients with ankylosing spondylitis.MethodsA retrospective study including 50 patients with...

FRI0166 Ankylosing Spondylitis Associated ERAP1 Variants Alter the Unfolded Protein Response

BackgroundEndoplasmic reticulum aminopeptidase 1 (ERAP1) has recently been identified to be strongly associated with HLA-B27 positive AS. We have shown that ERAP1 variants cause changes in free heavy chain (FHC)...

THU0098 The Baseline Characteristics of A Canadian Ankylosing Spondylitis Cohort, the Canadian Humira Post Marketing Observational Epidemiological Study: Assessing Effectiviness in Ankylosing Spondylitis (COMPLETE- AS)

BackgroundCOMPLETE-AS is an ongoing, multicenter, observational epidemiological study expected to enroll a total of 1,120 patients with ankylosing spondylitis (AS) from approximately 60 sites across Canada. The main objectives of...

THU0087 Influence of Sex and HLA B27 on Enthesis in Early Spondyloarthritis. an Ultrasound Study

BackgroundSpondyloarthritis (SpA) is a group of disorders that are characterized by inflammatory involvement of the enthesis and the adjacent bone. The importance of enthesis has increased over the last years...

THU0078 Hla-B27 Prevalence in Patients with Ankylosing Spondylitis in A Province of Japan, Compared with Tokyo

BackgroundIn western countries, prevalence of HLA-B27 antigen is highly associated with ankylosing spondylitis (AS) (1). Recent study pointed out the prevalence of HLA-B27 antigens in geographically adjacent regions may vary...

0391: Cardiac involvement in ankylosing spondylitis

Cardiac involvement in ankylosing spondylitis is common. We have tried through this study to analyze the cardiovascular events among 50 patients with ankylosing spondylitis. A retrospective study including 50 patients with ankylosing spondylitis. All patients underwent a complete physical examination with a heart and lung auscultation and an electro-cardiogram (ECG). Transthoracic ultrasound was performed whenever there was an abnormal physical examination and/or ECG. The study included 47 men and 3 women, the sex ratio is 15,6. The average age of onset was 26±7 years. The mode of onset is axial in 95% of cases (low back pain and/or buttock). The extra-articular manifestations are present in 54% of cases. Cardiac involvement is present in 9 cases (18% of cases). The reason for consultation is dyspnea in 2 patients. In other cases, cardiac involvement was discovered incidentally. Aortic regurgitation was noted in 4 patients. Mitral insufficiency was found in 3 cases. Two patients have predominantly septal hypertrophic cardiomyopathy and one patient presented an array of pulmonary insufficiency. The average time of onset of cardiac involvement was 8±5 years. All patients were put under special medical treatment of their heart, with good clinical outcome. Cardiac involvement in ankylosing spondyllitis is seen more frequently in men, especially in the old cases. A close relationship between time to onset of aortic insufficiency and duration of disease progression was found. It would be responsible for one third of deaths of patients. It was significantly more frequent in HLA B27 positive patients (especially complete atrioventricular block and aortic insufficiency).