Human Leukocyte Antigen B27 Positivity Research Articles

SYSTEMIC IMMUNE INFLAMMATION INDEX AND PAN-IMMUNE INFLAMMATION VALUE IN PREDICTING HUMAN LEUKOCYTE ANTIGEN-B27 POSITIVITY: A STUDY ON ANKYLOSING SPONDYLITIS PATIENTS

Objective: Ankylosing spondylitis (AS) is defined as both an auto-immune and autoinflammatory illness. Human leukocyte antigen B27 (HLA-B27), which is extensively employed in the diagnosis of chronic inflammatory diseases, is the basic laboratory parameter of axial spondylarthritis including AS. Systemic immune-inflammation index (SII) and pan-immune-inflammation value (PIV), obtained by formulating complete blood count parameters, are promising biomarkers that reflect systemic inflammation and local immune response and predict prognosis in diseases. The aim of this study was to investigate the sensitivity and specificity of SII and PIV biomarkers in predicting HLA-B27 positivity in AS patients. Materials and Methods: The research included 68 individuals with HLA-B27 tests (+) (AS group) and 102 patients with HLA-B27 tests (-) (control group). Results: In the AS group, lymphocyte and mean platelet volume values were determined to be lower than in the control group, while other complete blood count parameters, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), were found to be higher. While the SII and PIV values of the AS group determined a positive relation with CRP and ESR levels, they did not show a correlation in the control group. While the sensitivity for PIV in predicting HLA-B27 positivity was found to be 83.80% and the specificity was found to be 84.30%, for SII the sensitivity was found to be 83.80% and the specificity was found to be 86.30%. Conclusion: Easily and rapidly accessible biomarkers SII and PIV can potentially be used to predict HLA-B27 positivity in AS patients.

Beyond the spine: a case of ankylosing spondylitis complicated by secondary amyloidosis

BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory condition primarily affecting the spine and sacroiliac joints, often associated with human leukocyte antigen B27 (HLA-B27) positivity. While musculoskeletal symptoms are typical manifestations, AS can also lead to systemic complications, including secondary systemic amyloidosis (SSA), also known as Amyloid A (AA) amyloidosis, involving multiple organs.Case presentationWe present a case of a 45-year-old Asian male with a complex medical history, including diabetes and hypertension, who developed AS complicated by SSA. The patient exhibited a diverse range of symptoms, including cardiac, renal, gastrointestinal, and musculoskeletal manifestations. He reported shortness of breath on exertion, orthopnea, pedal edema, generalized weakness, back pain, neck pain, low-grade fever, decreased appetite, frothy urine, and significant weight loss over the past year. Diagnostic evaluations revealed HLA-B27 positivity and histologically confirmed AA amyloidosis, providing a comprehensive understanding of the systemic involvement.ConclusionThis case report highlights the intricate interplay between AS and SSA, particularly AA amyloidosis, with a focus on its systemic impact beyond musculoskeletal symptoms. The tragic outcome, marked by severe cardiac involvement, underscores the challenges in managing such complex cases. This report emphasizes the importance of early diagnosis and treatment of AS to prevent severe complications, along with vigilant monitoring and individualized treatment plans, as well as the need for further research to enhance our understanding and improve management strategies for AS-related amyloidosis.

Victim of Neglect: Juvenile Spondyloarthropathy (Juvenile-onset Ankylosing Spondylitis)

Spondyloarthropathy refers to a group of overlapping disorders that include spondylitis, sacroiliitis, asymmetrical peripheral arthritis, and enthesitis. If the onset is before 16 years of age, the condition is known as juvenile-onset spondyloarthropathy. We report a case of a 20-year-old male, who presented with history of pain in the left hip joint for 5 years, and pain in the right hip joint for the last 4 months. Flexion deformity of the left hip joint was noted at presentation. He was advised hip replacement at another center. A much delayed rheumatological evaluation revealed bilateral sacroiliitis, eye features of old iritis, and human leukocyte antigen B27 positivity. A positive family history was also present. He was diagnosed as a case of juvenile-onset ankylosing spondylitis and started on appropriate treatment. Timely recognition and management of juvenile spondyloarthropathy go a long way in preserving joints and quality of life.

The association between refractory plantar fasciitis and insertional Achilles tendinopathy and peripheral spondyloarthritis: a report of human leukocyte antigen B-27 investigation and treatment outcome.

This study aimed to determine the presence of peripheral spondyloarthritis and investigate the clinical characteristics of patients with concurrent peripheral spondyloarthritis in those presenting with refractory plantar fasciitis and Achilles tendinopathy by conducting human leukocyte antigen B-27 (HLA-B27) testing. This retrospective study aimed to investigate patients who complained of persistent pain and significant limitations in daily activities due to their respective foot pain, despite receiving conservative treatment for over one year under the diagnosis of plantar fasciitis or insertional Achilles tendinopathy. The study included 63 patients who underwent HLA-B27 testing. The patients were classified into two groups based on the presence or absence of HLA-B27 positivity. The Mann-Whitney U test assessed significant relationships between continuous variables, and the chi-square test was used to compare categorical variables. Among the 63 included patients, HLA-B27 positivity was confirmed in 11 patients (17.5%), which was significantly associated with a lower average age (22.8years versus 31.7years, P = 0.01) and a substantially lower proportion of females compared to HLA-B27-negative patients (9.1% vs. 25.0%, P = 0.001). Ten of the 11 patients initiated treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) combined with oral steroids as the first-line medication after being diagnosed as HLA-B27 positive. Six patients experienced pain relief with the first-line medication (60%). Four patients who did not achieve pain control with the first-line medication received tumour necrosis factor-alpha inhibitors as the second-line medication. Two patients experienced pain relief, while two experienced reduced but persistent pain. Among the patients with "refractory" plantar fasciitis and insertional Achilles tendinopathy, 17.5% were diagnosed with peripheral spondyloarthritis. Patients diagnosed with peripheral spondyloarthritis had a higher proportion of men and relatively younger mean age compared to those without the diagnosis. Approximately 70% of these patients achieved symptom improvement in foot and ankle joints by taking conventional synthetic DMARDs, TNF-α inhibitors, or both appropriate for spondyloarthritis.

Development of ankylosing spondylitis in patients with ulcerative colitis: A systematic meta-analysis.

Ulcerative colitis (UC) is a manifestation of inflammatory bowel disease (IBD), which can cause inflammation of the intestinal tract. Ankylosing spondylitis (AS) is an inflammatory disease of the sacroiliac joints. Many studies have found that some UC patients progress to AS. In this study, we conducted a literature search and meta-analysis to investigate the prevalence of AS among UC patients during follow-up. The studies related to the AS among patients with UC were obtained from PubMed, Web of Science, Embase, and Cochrane Library databases since its inception-December 2022. The literature was screened strictly according to inclusion and exclusion criteria. Forest plots were used to detect the overall incidence of AS in UC and to compare the risk ratios for the development of AS in the UC. The heterogeneity of studies was assessed using I2 statistical methods. 1) 17 studies with 98704 UC patients were included. 2)700 UC patients developed AS during follow-up (1.66%, 95% CI: 0.89-2.62%). Human leukocyte antigen B27 (HLA-B27) was reported in 3 studies. HLA-B27 positivity was significantly higher than the incidence of HLA-B27 negativity in AS patients (68.29% vs 31.71%, P < 0.0001). There was significantly increased risk of AS development in HLA-B27 positive IBD patients (RR: 22.17, 95% CI: 11.79-41.66, P < 0.0001). 3)The definite follow-up time was reported in 12 studies (range: 0.3-40 years). After follow-up for ≥5 years, the incidence of AS among patients with UC was 1.75% (95% CI: 0.62-3.37%). Meanwhile, after follow-up for <5 years, the incidence of AS among patients with UC was 1.41% (95% CI: 0.65-2.37%) which was significant. Patients with UC are more likely to develop AS in the future. Furthermore, the IBD patients are at a higher risk of AS who have positive HLA-B27. The incidence of AS increased with longer follow-up time.

Aksiyel Spondiloartrit, Sistemik Lupus Eritematozus, Sjögren Sendromu ve Sekonder Antifosfolipid Sendromunun Birlikte Görüldüğü Olgu Sunumu

Hereby we report a 55-year-old female patient having the association of non-radiographic axial spondyloarthritis (nr-AxSpA), systemic lupus erythematosus (SLE), secondary antiphospholipid antibody syndrome (APS), and Sjögren's Syndrome (SjS). Diagnosis of nr-AxSpA was made based upon the presence inflammatory low-back pain, human leukocyte antigen B27 positivity, and presence of sacroiliitis only in magnetic resonance imaging (MRI). SLE was diagnosed with butterfly-shaped rash on her cheeks, inflammatory arthritis, photosensitivity, erythema involving dorsal inter-joint area of hand fingers, alopecia together with antinuclear antibody (ANA) and anti-dsDNA positivity, low serum complement levels, leucopenia and thrombocytopenia. Additional presence of sicca symptoms, low Schirmer I test, anti SSA/Ro and anti-SSB/La positivity, supported by positive labial salivary gland biopsy led to the diagnosis of SjS. Furthermore, this patient also had miscarriage at 16th week and cerebral vascular disease at 33 years. Besides, IgG and IgM anticardiolipin antibodies were found to be positive twice. Therefore, she was also diagnosed as secondary APS. She fulfilled the relevant classification criteria for AxSpA, SLE, SjS and APS. To our knowledge, this is the first case report showing the association of these four diseases, with different genetic, etiopathogenetic and clinical systemic inflammatory diseases.

Geographical prevalence of family history in patients with axial spondyloarthritis and its association with HLA-B27 in the ASAS-PerSpA study

BackgroundA positive family history (PFH) of spondyloarthritis (SpA) consists of five SpA-related entities, of which a PFH of axial spondyloarthritis (axSpA) is most common in European patients with axSpA. Moreover,...

Comparison of ankylosing spondylitis patients with and without fibromyalgia syndrome according to the disease activation scores and response to treatment.

Objectives The aim of this study was to investigate the association of fibromyalgia (FM) syndrome with ankylosing spondylitis (AS) and to compare the AS patients with and without FM according to the disease activity, clinical and laboratory findings, and response to treatment. Patients and methods Between September 2016 and September 2020, a total of 511 patients (312 males, 119 females; mean age: 43.0±11.2 years; range, 18 to 77 years) who were diagnosed with AS were retrospectively analyzed. Age, sex, disease duration, disease onset age, and extra-articular findings were recorded. Medical treatments used by the patients for the treatment of AS and FM were noted. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), human leukocyte antigen-B27 (HLA-B27) status, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) with ESR (ASDAS-ESR) and ASDAS-CRP values were recorded. Results The frequency of FM in AS patients was 23.2%. Totally, 75.4% of the FM patients were female. The HLA-B27 positivity, extra-articular involvement frequency, disease duration, and acute phase reactants levels were similar between AS patients with and without FM (p=0.118, p=0.154, p=0.829, p=0.113, and p=0.763, respectively). The AS patients with FM had lower rates of achieving remission or low disease activity, compared to those without FM. The mean of all three disease activity scores between these two groups was also higher in the AS patients with FM (p<0.001). The rate of use of biological therapy was significantly higher in the AS patients with FM than those without FM (p=0.037). Conclusion Since the treatment plan of AS is made based on the disease activity scores, unnecessary biological therapy may be initiated for patients or the biological therapies they use may be switched unnecessarily. Therefore, it should be kept in mind that FM may present with AS in patients who do not respond to treatment clinically, and this may be misinterpreted as treatment unresponsiveness.

The association of anti-CD74 antibody with spondyloarthropathies.

The etiopathogenesis of spondyloarthropathies (SpA) is still unclear. Recently, anti-CD74 antibody has been suspected to play a role in SpA etiopathogenesis. This study aimed to examine the levels of anti-CD74 antibody in patients with SpA and investigate their association with disease activity. This study was conducted using data from patients who were treated at the departments of rheumatology and gastroenterology between June 2013 and November 2013. The demographic and clinical characteristics of the participants and their serum IgG-type antibodies against anti-CD74 were analyzed. We analyzed 111 patients with ankylosing spondylitis (AS), 108 patients with inflammatory bowel disease (IBD), and 101 healthy controls. The rate of human leukocyte antigen-B27 positivity was 86.5% in patients with AS and 21.3% in patients with IBD. The mean levels of anti-CD74 antibodies in the AS, IBD, and control groups were 6.99±3.24 ng/mL, 6.25±3.34 ng/mL, and 7.83±4.72 ng/mL, respectively. Anti-CD74 levels were higher in healthy controls than in patients with IBD (p=0.009). There was no significant difference in anti-CD74 levels between the AS and IBD groups and the AS and control groups. In addition, there was no correlation between anti-CD74 levels and disease activity. This study could not find an association between anti-CD74 levels and SpA in Turkish patients.

Clinical, laboratory, and radiological characteristics of patients with late-onset spondylarthritis

IntroductionSpondylarthritis (SpA) is a chronic inflammatory disease that rarely began after 50 years of age. Aim of the work: To investigate the clinical, laboratory, and radiological characteristics of late-onset SpA (LOSpA) and compare them to early-onset (EOSpA). Patients and methods: A single-center cross-sectional study included 117 SpA patients and those with their initial symptoms starting after the age of 50 years were considered late-onset. Results: There were 102 patients (87.2%) with EOSpA and 15 (12.8%) with LOSpA. The mean age at onset for the EOSpA and LOSpA groups was 28.6 ± 9.1 and 54.5 ± 2.9 respectively. Female sex and presence of comorbidities were more associated with older age at onset (p = 0.03 and p = 0.008, respectively). Delay in diagnosis was shorter in the LOSpA group (p = 0.05), and they had less alternating buttock pain and hip involvement at onset of the disease (p = 0.005 and p < 0.001, respectively). Patients with EOSpA had more axial forms (p = 0.03). Uveitis, inflammatory bowel diseases (IBD), and human leucocyte antigen B27 (HLA-B27) positivity were significantly more common in the LOSpA group (p = 0.04; p = 0.05 and p = 0.04, respectively). There was no significant difference between the two groups in the laboratory investigations, anthropometric measures, and disease indices. Radiological findings were also comparable. Multiple logistic regression analysis revealed that only axial forms and HLA-B27 positivity were independently associated with the age of the disease onset. Conclusion: The late onset of the disease is more frequent in females with HLA-B27. The LOSpA patients had a shorter delay in diagnosis, more comorbidities, uveitis, and IBD.

Detection of Human Leukocyte Antigen B27 by Flowcytometry in Patients With Suspected Ankylosing Spondylitis in a Tertiary Care Centre.

IntroductionHuman leukocyte antigen B27 (HLA-B27) is strongly implicated in the pathogenesis of ankylosing spondylitis (AS). Hence, HLA-B27 testing is routinely used in the diagnosis of AS.ObjectivesWe aimed to establish the frequency of HLA-B27 in AS patients by flow cytometry and relate the differences between B27+ and B27- cases to the serum concentrations of rheumatoid arthritis factor (RA), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).Methods The study population included a total of 210 patients who visited the tertiary health care center. The peripheral blood samples obtained from AS patients were subjected to a qualitative two-color direct immunofluorescence method using the HLA-B27/CD3 antibody for the rapid detection of HLA-B27 antigen expression in erythrocyte-lysed whole blood in FACSCalibur flow cytometer (Becton Dickinson, USA).ResultsOut of 210 AS patients, the distribution of HLA-B27 positivity was observed only in 46 (22%) patients. The remaining 164 patients (78.1%) were negative for HLA-B27. Of the 46 HLA positive patients, 39 (25.34%) were males and only seven (12.5%) were females. In both sexes, HLA-B27 frequency was significantly higher in the age group 21-30 years, followed by 41-50 years. The current study also revealed a significant association between sex and age of onset of HLA‑B27 detection in patients with suspected AS. Disease activity was not significantly correlated with RA, ESR, and CRP.ConclusionsThe detection of HLA-B27 by flow cytometry proved to be a reliable test in the screening of AS in the Indian population.

Prevalence of Human Leukocyte Antigen B27 Positivity and Microbiological Profiles of Patients with Reactive Arthritis – A Cross Sectional Study

The present study aims to determine the spectrum of etiological agents and to screen HLA-B27 and, related inflammatory markers in patients presenting with symptoms of Spondyloarthritis(SpA) post diarrhea, which can aid in prompt diagnosis of reactive arthritis (ReA). A total of 903 stool samples of patients presenting with diarrhea were collected and screened with microscopic and culture techniques to identify the etiological agents. Blood samples of patients presenting with both diarrhea and arthritis were collected and subjected to C- reactive protein(CRP), Erythrocyte sedimentation rate(ESR) and Human Leukocyte Antigen B27(HLA-B27) detection tests.Among the total of 903 patients, 20 Salmonella species were isolated. Othergut microbes identified included Escherichia coli 572(63%), Klebsiella species 126(14%), Proteus vulgaris 43(5%), Proteus mirabilis 27(3%), Citrobacter species and Enterococcus species 8(1%), while some of these organisms(3.2%) caused inflammation resulting in ReA. Parasitic etiology was found in 99 patients, among which the most common parasites include Entamoeba histolytica and hookworm, identified through microscopy. Among the total, 29 patients were found to have symptoms of joint pain with articular and extra articular manifestations, and some associated with HLA-B27.

Human Leukocyte Antigen B27 (HLA-B27) in the General Population in the Kingdom of Saudi Arabia.

Determining the prevalence of the human leukocyte antigen B27 (HLA-B27) in the general population in the Kingdom of Saudi Arabia. This cross-sectional study was performed at King Abdulaziz University in the period May 23, 2019 - August 31, 2019 and included four hundred Saudi healthy blood donor subjects (200 male [50%]). We used blood samples in ethylenediaminetetraacetic acid (EDTA) tubes. The HLA-B27 alleles were detected by the Single Specific Primer-Polymerase Chain Reaction (SSP-PCR) using the HLA-B27 Screen Real Time kit from BioDiagene S.R.L (Palermo, Italy). Data analysis was achieved by the statistical package for social science (IBM SPSS Inc., version 20). Ten (2.5%) were positive for HLA-B27 (6 female [60.00%]). HLA-B27 positivity in blood groups was 3% in O and B, 1.7% in A, nil in AB but almost equal in Rh+ve (2.5 %) and Rh-ve (2.4 %) blood groups, with no significant difference neither between male and female (p = 0.52), nor between blood groups (p = 0.77). The prevalence of 2.5% for HLA-B27 in the general Saudi population was similar to that of Omair et al. using samples of Saudi cord blood [14]. The positivity in females was 1.5 times higher than in males. No correlation was seen between HLA-B27 and gender and blood groups.

Possibilities of screening for a high-risk axial skeletal lesion in psoriatic arthritis

Objective: to determine a set of signs that are prognostically significant for identifying a high-risk axial skeletal lesion in early psoriatic arthritis (ePsA).Patients and methods. Examinations were made in 95 patients (47 men and 48 women) with peripheral arthritis lasting for ≤2 years, who met the 2006 Classification Criteria for Psoriatic Arthritis (CASPAR). The clinical characteristics of the patients were presented in our previously published work. In all the patients, a standard examination was made and the signs of inflammatory back pain (IBP) were identified according to the Assessment of SpondyloArthritis International Society (ASAS) criteria, the presence of human leukocyte antigen B27 (HLA-B27) was determined, and pelvic bone X-ray was done; regardless of whether they had IBP, 79 patients underwent magnetic resonance imaging (MRI) of the sacroiliac joints using a low-field Signa Ovation 0.35 T. Sacroiliitis (SI) diagnosed based on radiography (rSI) was considered reliable if there were bilateral changes corresponding to at least Stage II or unilateral changes corresponding to at least Stage III according to the Kellgren system. SI diagnosed based on MRI (MRI-SI) was regarded as active when osteitis was detected in the STIR mode in the bones adjacent to the joint on at least two slices or in the presence of two signals in a slice. X-ray and MRI results were assessed by an independent radiologist. The extent of a skin lesion was determined from the body surface area (BSA): the extent was regarded insignificant, moderate, and significant with involvements of &lt;3%, 3–10%, and &gt;10%, respectively.The patients were divided into two groups. Group 1 included 65 (68.4%) patients with the manifestations of axial PsA (axPSA): IBP, and/or rSI, and/or MRI-SI; Group 2 consisted of 30 (31.6%) patients without axial manifestations, only with peripheral PsA (pPsA). Multivariate stepwise discriminant analysis was used to identify a group of signs that were most characteristic of axPsA.Results and discussion. Comparative analysis of the two groups showed that there were more males among patients with axPsA than among those with pPsA (39 (60%) and 8 (26.7%), respectively) (p=0.003). HLA-B27 positivity was also more often detected in patients with axPSA than in those with pPsA (30 (46.6%) and 7 (23.3%) patients, respectively) (p=0.02). In the axPSA group, there were significantly more individuals with moderate and high DAS, high CRP levels, and a more severe skin lesion (BSA &gt;3%).The investigators obtained the following discriminant classification rule associated with axPSA: 1.566 (if CRP is &gt;5 mg/L) + 0.957 (if HLA-B27 is positive) + 0.986 (if BSA is &gt;3%) + 1.845 (if DAS is moderate or high) + 0.6 (if the sex is male) &gt;3.751 (p=0.0025). The sensitivity and specificity of the model were 68% and 73%, respectively.Conclusion. The combination of signs, such as male sex, HLA-B27 positivity, high or moderate DAS, CRP &gt;5 mg/L, the extent of skin lesions according to BSA &gt;3%, is prognostically significant for identifying high-risk axial skeletal lesion in ePSA. The proposed mathematical model can be used to screen patients for the early diagnosis of an axial lesion in ePSA.

Measuring Choroid Thickness as a Marker of Systemic Inflammation in Patients With Ankylosing Spondylitis.

Ankylosing spondylitis (AS) is an inflammatory disease, and choroidal thickness (CT) has been proposed and evaluated as a potential marker of systemic inflammation associated with AS and other inflammatory diseases. This study compared CT measurements taken from patients with severe AS disease activity without eye inflammation with those taken from healthy subjects. This cross-sectional, multicenter study compared CT in 44 patients with high AS disease activity, and no history of eye inflammation with CT in 44 matched healthy subjects aged between 18 and 65 years. In the AS group, the correlation between CT and C-reactive protein, human leukocyte antigen (HLA) B27 positivity, disease duration, and disease activity was calculated. Mean CT values of patients with AS were significantly higher in the right eye, the left eye, and the thickest choroid eye. The right eye mean CT was 338.3 ± 82.8 μm among patients with AS and 290.5 ± 71.2 μm among healthy subjects (p = 0.005). The left eye mean CT was 339.5 ± 84.7 μm for patients with AS and 298.4 ± 68.9 μm for healthy subjects (P = 0.015). The thickest choroid eye CT was 358.4 ± 82.1 μm among patients with AS and 314.1 ± 65.2 μm among healthy subjects (P = 0.006). We did not find a significant correlation between CT and disease activity, C-reactive protein, human leukocyte antigen B27 positivity, or disease duration. Patients with active AS but without a history of eye inflammation had a thicker choroid than healthy subjects. This finding suggests that CT is a marker of systemic inflammation in patients with inflammatory disease, regardless of known eye symptoms.

Correlation of Radiographic Findings of Sacroiliac Joint with Clinical Profile in Patients with Inflammatory Low Back Pain: An Observational Study

Introduction: Inflammatory back pain (IBP) is a prominent clinical symptoms in patients with spondyloarthropathy (SpA) affecting young adults and is an important cause of morbidity in the productive age group. SpA characteristically involves sacroiliac joints (SIJs). For the diagnosis of early sacroiliitis, though magnetic resonance imaging (MRI) is the preferred method, conventional radiography has been routinely used for the evaluation of sacroiliitis. Active inflammation in SIJs cannot be assessed on radiographs and they usually appear normal in the early phase of IBP. This study aims to study the clinical and radiographic patterns of IBP in Indian scenario. Materials and Methods: Treatment naive patients with low back pain and subsequently diagnosed with IBP as per Calin criteria were identified. The clinical and laboratory parameters of these patients were recorded. SIJ radiographs of these patients were analyzed. Results: Fifty-two patients were registered with 57% of subjects being female. The mean age of onset of symptoms was 32–33 years with a mean duration of symptoms being 40.9 months. No significant difference was noted in the age of onset or duration of illness in males and females. Human leukocyte antigen-B27 (HLA-B27) positivity rate was only 8.7%. About 38.4% of cases demonstrated active inflammation at presentation. Most of the cases (94.2%) though presented for the first time had radiographic evidence of sacroiliitis. A maximum number of cases (38.4%) were seen in Grade 2, followed by Grade 3 (30.8%). Cases with symmetrical sacroiliitis were more (57.1%) as compared to asymmetrical/unilateral sacroiliitis. HLA-B27 positivity in symmetric cases was 10.9% as against 12.5% in asymmetric cases. Conclusions: There is often delay in the diagnosis of sacroiliitis. This is, in contrast, to profile in developed nations where early detection of the disease occurs ultimately leading to the usefulness of early therapy. Appropriate measures need to be taken in the health-care sector to increase awareness among people and treating physicians and sensitize them to IBP and its associated morbidities. In the present scenario, where the majority of cases are presenting in the chronic stage of the disease, radiography may be advocated in resource poor areas to decrease burden and cost related to the use of MRI.

Chronologic order of appearance of immune-mediated inflammatory diseases relative to diagnosis of psoriasis

Psoriasis is a common inflammatory skin disease associated with several immune-mediated inflammatory diseases (IMIDs); however, little is known of the chronology of disease development. To investigate the chronology of IMIDs relative to psoriasis. We utilized routinely collected data from Danish nationwide administrative registries to examine the occurrence of IMIDs in patients with psoriasis (n=10,923) and general population controls (n=109,230). Approximately 20% of patients with psoriasis developed ≥1 IMID, with a 5-fold increased risk compared with the general population. Most IMIDs were diagnosed before psoriasis, except for psoriatic arthritis. Psoriasis was significantly associated with having multiple IMIDs (odds ratio 15.2, 95% confidence interval 11.6-20.0). Human leukocyte antigen B27 positivity was significantly more frequent among psoriasis patients. Clinical measurements were unavailable. IMIDs occur frequently in patients with psoriasis and most are diagnosed before psoriasis. The observed chronology might represent important mechanisms of disease development.

Serum miR-214 as a novel biomarker for ankylosing spondylitis.

Serum microRNA (miR) in ankylosing spondylitis (AS) patients has been rarely identified. The objective of this study was to find AS-specific miR in sera of patients with AS. Total RNAs were isolated from whole sera of patients with AS, patients with rheumatoid arthritis (RA), and healthy controls (HC) using miRNeasy Serum/Plasma Kit. The presence of miR was assayed using Agilent 2100 Bioanalyzer Small RNA assay. Each RNA sample was used for miR microarray. To verify microarray results, candidate circulating miRs were validated by quantitative polymerase chain reaction (qPCR) using samples from patients with AS (n=65), patients with RA (n=25), and HCs (n=39). Cycle threshold values were converted to copy numbers by drawing a standard curve using a synthetic chemical standard. All clinical values were also evaluated at the time of miR isolation. A total of 887 miRs were screened for three groups. Lower expression of miR-214 in AS than in HC and RA was observed after normalization of raw data. Finally, lower expression of serum miR-214 was confirmed in AS after validation by qPCR. Correlation analysis showed that the level of miR-214 of AS was significantly associated with Ankylosing Spondylitis Disease Activity Score-C-reactive protein (r=0.299, P=0.02). However, other disease-specific variables showed no statistical significance: gender (P=0.286), peripheral arthritis (P=0.634), enthesitis (P=0.464), dacylitis (P=0.750), psoriasis (P=0.552), inflammatory bowel disease (P=0.369), human leukocyte antigen-B27 positivity (P=0.473), use of non-steroidal anti-inflammatory drugs (P=0.448), and use of tumor necrosis factor-blocker in the last 3months (P=0.505). miR-214 may serve as a noninvasive biomarker for diagnosis of AS. In addition, expression level of miR-214 was associated with disease activity.

Uncovering the heterogeneity of disease impact in axial spondyloarthritis: bivariate trajectories of disease activity and quality of life

ObjectiveThe goal of managing axial spondyloarthritis (axSpA) is to improve and maintain patients’ health-related quality of life (HRQoL), mainly through targeting towards low disease activity. Here, we aim to gain...

Clinical Associations of Uveitis in Axial Spondyloarthritis Group and Ankylosing Spondylitis Group: Do They Represent the Same Disease?

The aim of this study was to determine the prevalence and associated factors for uveitis in ethnic Chinese patients with axial spondyloarthritis (SpA) and ankylosing spondylitis (AS). This was a cross-sectional study. Patients fulfilling the Assessment of SpondyloArthritis international Society axial SpA criteria were recruited consecutively from 3 rheumatology centers in Hong Kong from March 2014 to July 2017. Clinical and biochemical parameters were collected. History of uveitis was inquired from both history and medical records. All patients received lumbosacral spine x-rays and whole-spine and sacroiliac joint magnetic resonance imaging. Patients were defined as axial SpA if they fulfilled the Assessment of SpondyloArthritis international Society criteria and AS if they fulfilled the modified New York criteria. Clinical and radiological findings were compared between patients with and without uveitis in the 2 groups. Factors associated with uveitis were identified with univariate analyses and multivariate logistic regression analyses. Among 252 patients, 67 patients (26.6%) had a history of uveitis. The male-to-female ratio was 55.4 to 44.6. Disease duration was 12.3 ± 11.7 years. In the axial SpA group, multivariate regression showed that older age (odds ratio [OR], 1.05; p = 0.01), human leukocyte antigen B27 positivity (OR, 11.79; p = 0.01), and history of inflammatory bowel disease (OR, 9.74; p = 0.04) were positively associated with uveitis. In the AS group, multivariate regression showed that back pain duration (OR, 1.05; p = 0.01) and male sex (OR, 3.46; p = 0.03) were associated with uveitis. Axial SpA represents a spectrum of diseases. Its clinical associations with uveitis should be distinguished from those of traditional AS.