Inflammatory Low Back Pain Research Articles

Concomitância de artrite reumatoide e espondilite anquilosante em um único paciente: importância dos novos critérios de classificação

Relatamos um caso de concomitância de espondilite anquilosante e artrite reumatoide em um paciente caucasiano de 65 anos, com achados clínicos de poliartrite simétrica com erosão de metacarpofalangeana ao raio X convencional e dor lombar inflamatória, HLA-B27+, associada à sacroiliíte. O paciente apresentou valores elevados de fator reumatoide e antipeptídeo citrulinado cíclico (anti-CCP). Realizamos uma revisão da literatura na qual as principais características de casos previamente reportados foram comparadas às deste caso. Este é o primeiro relato de caso de concomitância das duas doenças em que se utilizou teste laboratorial para dosagem do anti-CCP associado ao preenchimento das últimas versões dos critérios ASAS axial e ACR/EULAR para a classificação de espondilite anquilosante e artrite reumatoide, respectivamente.

Concurrent rheumatoid arthritis and ankylosing spondylitis in one patient: the importance of new classification criteria

We report the case of concomitant ankylosing spondylitis and rheumatoid arthritis in a 65-year-old Caucasian male, who had symmetric polyarthritis with erosion of the metacarpophalangeal joint on conventional X-ray, inflammatory low back pain with HLA-B27 positivity, and sacroiliitis. Laboratory analysis showed high levels of rheumatoid factor and anti-cyclic citrullinated peptide antibody (anti-CCP). Clinical features of previously reported cases were compared with those of our case. This is the first case report on the coexistence of both diseases in the same patient, for whom anti- CCP testing and the latest versions of axial ASAS criteria and ACR/EULAR criteria for the classification of ankylosing spondylitis and rheumatoid arthritis, respectively, were used.

Coexistence of Ankylosing Spondylitis and Klinefelter's Syndrome

Ankylosing spondylitis is a chronic inflammatory disease characterized by inflammatory lower back pain and morning stiffness and accompanied by spine and sacroiliac joint involvement. Klinefelter's syndrome is a genetic condition that only affects males. Affected males have an extra X chromosome. This paper reports a 30-years-old male on followup with the diagnosis of Klinefelters syndrome. The patient admitted with complaints of inflammatory lower back, and neck pain and morning stiffness and was diagnosed with ankylosing spondylitis. Nonsteroidal anti-inflammatory drug and salazopyrine treatment resulted in significant regression in his complaints.

Ewing’s Sarcoma Presenting as Hip Monoarthritis in a Spondyloarthritis Patient

Seronegative spondyloarthritis (SpA) and Ewing’s sarcoma (ES) are common disorders affecting young males. A great challenge is to diagnose both diseases in the same patient. Here we describe a case of a young male patient having SpA, who developed ES that presented as monoarthritis of left hip which was misdiagnosed twice; first as peripheral manifestation of SpA and second as septic arthritis; before the correct diagnosis was reached. A 17 year-old boy presented with inflammatory low back pain of gradual onset lasting for 4 months and knee arthralgias. Examination revealed the presence of localized tenderness over both SIJs and limited lumbar flexion. Plain x-ray showed bilateral grade 2 sacroiliitis and he was Rheumatoid factor negative. The diagnosis of seronegative SpA was made based on fulfillment of the Association of Spondyloarthritis International Society classification criteria for axial SpA. Nonsteroidal anti-inflammatory drugs (NSAIDs) and sulphasalazine were prescribed resulting in rapid improvement of back pain and knee arthralgia. Four months later, the patient had increased severity of his back pain with pain at the left hip region associated with painful limited internal hip rotation. The diagnosis of left hip arthritis associated with SpA was made without requesting imaging study at that time. The dose of NSAIDs was increased and a low dose steroid was added. Few days later, the general condition of the patient deteriorated with the development of night fever, poor night sleep and poor appetite. On presentation, the patient looked very ill with fever. Hip examination revealed marked painful limited hip movement with flexion deformity. New investigations revealed an ESR of 110 mm/hr, and a CRP of 88 mg/L. There was normochromic normocytic anemia (HB: 9g/dl) and leucocytosis (WBC: 13.300/µL). The diagnosis initially considered was acute septic arthritis. Left hip arthrocentesis failed to aspirate any fluid and ultrasound revealed the absence of joint effusion. A multislice computerized tomography (CT) revealed the presence of a destructive osseous lesion targeting the left pubic bone and the left acetabulum with intra-articular extension into the left hip joint causing bony erosion of the medial aspect of the left femoral head. An MRI showed intra-pelvic extension with enlarged iliac lymph nodes. A biopsy was obtained from the mass. Histopathology revealed a malignant round-cell tumor consistent with ES. The patient was referred for chemotherapy and we knew that he was started on a combination of drugs for a short time before he died. To the best of our knowledge this is the first report in literature of ES in SpA patient and the second report of ES presenting as hip monoarthritis. Keywords: Ewing’s sarcoma, spondyloarthritis, arthritis. Read more →

Myeloma with biclonal IgG lambda and IgD kappa in serum : a case report

Event Abstract Back to Event Myeloma with biclonal IgG lambda and IgD kappa in serum : a case report Sana Khlif1* 1 Department of Immunology Habib Bourguiba university hospital, Tunisia IgD myeloma is a rare entity (1-3%). Kappa subtype contributes only 10-30% of IgD myelomas and biclonal gammopathies involving IgD are even more rare. In fact, biclonal bands constitute only 3-4% of all myelomas. Case report : We report the case of a 57 years old women, who presented inflammatory low back pain and experienced a severe decline in general health. The symptoms were present 3 months before diagnosis. Laboratory test abnormalities included an elevated erythrocyte sedimentation rate (100mm /h), normochromic normocytic aplastic anemia, hypercalcemia (2,92 mmol/l), hyper-β2-microglobulin (2,87 mg/l). Serum protein electrophoresis showed hypergammaglobulinemia with a monoclonal peak in gamma region. Immunofixation detected an IgD Kappa band and a faint IgG lambda one. Bone marrow aspirated from the sternum was found to contain 30% of malignant plasma cells. Radiograph magnetic resonance imaging (MRI) disclosed myelomateous infiltration of dorsolumber spine and spondylolisthesis, with no evidence of spinal cord compression. IgD myeloma is a particular severe form of myeloma often associated with poor prognosis. The pathogenesis is unclear. This case presents interesting findings regarding prognosis: We discuss, on one side, pronostic significance of biclonal gammopathy with IgD-Κappa comparing to the monoclonal IgD myelomas. On the other side, we analyze particularities of the IgD Kappa compared to the typical IgD lambda. Keywords: biclonal gammapathy, IgD myeloma, kappa subtype, Myeloma Proteins, pronostic Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Immune-mediated disease pathogenesis Citation: Khlif S (2013). Myeloma with biclonal IgG lambda and IgD kappa in serum : a case report. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.01141 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 19 Aug 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Sana Khlif, Department of Immunology Habib Bourguiba university hospital, sfax, Tunisia, sanakhlif@yahoo.fr Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Sana Khlif Google Sana Khlif Google Scholar Sana Khlif PubMed Sana Khlif Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Differential Diagnosis and Management of Ankylosing Spondylitis Masked as Adhesive Capsulitis: A Resident's Case Problem

Resident's case problem. Ankylosing spondylitis is a potentially debilitating seronegative spondyloarthropathy, with inflammatory low back pain as the most commonly reported symptom. In the absence of low back pain, identification of other diagnostic criteria or associated impairments and joint involvement, such as involvement of the hip or shoulder, may be beneficial. A 32-year-old man with right shoulder pain and decreased range of motion was referred with a diagnosis of adhesive capsulitis. He had been managed by multiple healthcare providers for 3 years before being referred to a physical therapist. Glenoid labral pathology was evident on prior magnetic resonance imaging, which had led to a persistent focus on the shoulder. The evaluation by the physical therapist revealed significant mobility deficits in the cervical, thoracic, and lumbar spine. Radiographs and laboratory tests were ordered and a referral was made to rheumatology after the initial physical therapy assessment. The diagnostic work-up confirmed the diagnosis of ankylosing spondylitis and led to multidisciplinary management of the disease. Low back pain is often the primary symptom of ankylosing spondylitis later in the disease process. Earlier indicators of ankylosing spondylitis, such as severely impaired mobility and spine stiffness, may help guide detection in the absence of spinal pain. In this case, an appropriate diagnosis led to improvement in the management strategy of what might have appeared to be unrelated shoulder pain. Early differential diagnosis is important, as emerging interventions show promise when used earlier in the disease process.

Sacroiliitis-like pain as the initial presentation of primary hyperparathyroidism

Hyperparathyroidism often presents with asymptomatic hypercalcemia or minimal, unspecific symptoms and the middle-age female is the predominant population. We reported a young Vietnamese female with primary hyperparathyroidism presented with chronic low back pain of about 1year duration, similar to sacroiliitis. An initial study of bone scan raised the suspicion of sacroiliitis. However, careful review of her symptoms and signs did not demonstrate the presence of typical inflammatory low back pain instead of severe osteoporosis and osteitis fibrosa cystica. A computed tomography of pelvis showed subchondral bony resorption or erosive change with bilateral SI joint widening which more favored hyperparathyroidism than sacroiliitis. This case highlights the point that primary hyperparathyroidism could be presented with sacroiliitis-like pain and severe bone disease in young patient from a developing country.

Sulphasalazine-induced aseptic meningitis with facial and nuchal edema in a patient with spondyloarthritis

Sulphasalazine-induced aseptic meningitis with facial and nuchal edema in a patient with spondyloarthritis

Sakroiliitis oder Pseudosakroiliitis?

When the presence of seronegative spondyloarthropathy is unrecognized there can be a delay in achieving an accurate diagnosis, as the typical inflammatory low back pain is similar to that found in degenerative diseases of the lumbosacral spine and the sacroiliac joints. Thus, seronegative spondyloarthropathy is often misinterpreted as a degenerative disease. The initial radiography of the sacroiliac joints is often normal which results in a delay in diagnosis of sacroiliitis of approximately 3-7 years. This illustrates the significance of an adequate imaging method for the early detection of sacroliliitis. Contrast medium administration for magnetic resonance imaging (MRI) enables a differentiation between synovitis, capsulitis, enthesitis and effusion. Sensitivity and specificity for detection of active inflammation by MRI is about 83-85%. Early active inflammation can be detected by MRI 3-7 years before structural changes are obvious by x-ray examination. Pseudosacroiliitis can be differentiated from inflammatory sacroiliitis by the patient history, laboratory data, osteoproliferative and osteodestructive changes and the typical distribution pattern of bone marrow edema.

Marked Reduction of Sacroiliac Joint Inflammation on Magnetic Resonance Imaging in a Patient with Ankylosing Spondylitis After Rituximab Treatment: Figure 1.

To the Editor: Rituximab, a chimeric monoclonal antibody directed against CD20 on B cells, is effective to treat rheumatoid arthritis (RA). Reports on the efficacy of rituximab in ankylosing spondylitis (AS) describe good results1,2,3, while there is no evidence that active inflammation on magnetic resonance imaging (MRI) in the spine or sacroiliac joints might be suppressed after treatment with rituximab. We describe a patient with AS receiving rituximab who showed improvement in clinical outcomes as well as MRI findings. A 20-year-old man was diagnosed with AS (HLA-B27-positive) in 2006. He had inflammatory lower back pain, bilateral sacroiliitis (radiological grade II), and left knee arthritis, and did not experience uveitis. His treatment consisted of nonsteroidal antiinflammatory drugs (NSAID) and sulfasalazine, and still he continued to … Address correspondence to Dr. J. Tang; E-mail: tangjp6568{at}yahoo.com

The use of low-dose etanercept as an alternative therapy for treatment of ankylosing spondylitis: a case series

During recent decades, biological medications play a crucial role for treating rheumatologic disorders and thus are strongly recommended for initial treatment of ankylosing spondylitis. However, because of high cost of biological drugs, the use of these drugs has been limited. In current series, we tried to assess safety of low-dose etanercept as a common usable biological drug in patients with ankylosing spondylitis. In a case-series study, 4 men with ankylosing spondylitis were treated with low-dose etanercept (25 mg/2 weeks) plus methotrexate (10 mg/week). Safety was assessed by measuring rate of differences in severity of clinical manifestations and level of C-reactive protein (CRP). After the completion of treatment with low-dose etanercept, inflammatory low back pain and morning stiffness was reduced lower than 30 min in all patients. Only one patient had baseline high serum ESR and positive CRP that was changed to negative following treatment protocol. At one-year follow-up, all participants continued their regular treatment regimen with the etanercept survival rate 100%. Neither side effects related to drug nor clinical complications were observed within the follow-up period. Our findings suggest that low-dose etanercept (25 mg/2 weeks) has an acceptable safety and effectiveness profile in individuals with ankylosing spondylitis and can be good alternative instead of conventional therapy with etanercept (25 mg two times per week).

Delineating inflammatory and mechanical sub-types of low back pain: a pilot survey of fifty low back pain patients in a chiropractic setting

BackgroundAn instrument known as the Mechanical and Inflammatory Low Back Pain (MAIL) Scale was drafted using the results of a previous expert opinion study. A pilot survey was conducted to test the feasibility of a larger study designed to determine the MAIL Scale's ability to distinguish two potential subgroups of low back pain: inflammatory and mechanical.MethodsPatients with a primary complaint of low back pain (LBP) presenting to chiropractic clinics in Perth, Western Australia were asked to fill out the MAIL Scale questionnaire. The instrument's ability to separate patients into inflammatory and mechanical subgroups of LBP was examined using the mean score of each notional subgroup as an arbitrary cut-off point.ResultsData were collected from 50 patients. The MAIL Scale did not appear to separate cases of LBP into the two notionally distinct groups of inflammatory (n = 6) or mechanical (n = 5). A larger "mixed symptom" group (n = 39) was revealed.ConclusionsIn this pilot study the MAIL Scale was unable to clearly discriminate between what is thought to be mechanical and inflammatory LBP in 50 cases seen in a chiropractic setting. However, the small sample size means any conclusions must be viewed with caution. Further research within a larger study population may be warranted and feasible.

Unusual Association of Ankylosing Spondylitis With Congenital Spinal Deformity

In all, 4 cases of the coexistence of congenital spinal deformity (CSD) and ankylosing spondylitis (AS) were reviewed. To provide an insight into the unusual association between CSD and AS. CSD combined with musculoskeletal anomalies, including clubfeet, Sprengel deformity, Klippel-Feil syndrome, and developmental dysplasia of the hip, has been described in the literature. Additionally, the rare coexistence between AS and other inflammatory joint diseases, such as systemic lupus erythematosus, mixed connective tissue disease, or Behçet disease, has also been reported. However, to the authors' knowledge, the coexistence of CSD and AS has not been described in the literature. In all, 4 patients presented with symptoms of lower back pain for at least 1 year. Among them, 3 patients (cases 1, 2, and 3) were initially diagnosed as CSD, and classified as butterfly vertebra in 2 patients (case 1, case 3), incarcerated hemivertebra in 1 patient (case 2). Furthermore, a diagnosis of coexistence of CSD and AS was proposed in these 3 cases with a delay in the diagnosis of AS for 1 to 10 years. The fourth patient sought initial medical attention in our hospital without delay in diagnosis. In case 1, polysegmental Smith-Petersen osteotomy and transpedicular fixation were performed, and drugs were administrated. Case 2, case 3, and case 4 were treated with amethopterin, folic acid, salicylazosulfapyridine, and celecoxib. At the latest follow-up, 4 patients had no back pain and were satisfied with the outcome. The coexistence of CSD and AS is very rare. However, it is necessary to consider the diagnosis of AS in CSD patients who present with symptoms such as inflammatory low back pain, morning stiffness, loss of global sagittal balance, and other clinical features can not be exclusively explained by CSD solely.

Promontofijación laparoscópica. Nuestra técnica

Objectives The pathology of the pelvic flool, including the urinary incontinence, the anal incontinence and the genital prolapse, is very dominant, concerning approximately a third of the adult women. It is fundamental that this musculature supports a good function, because of the weakness of the pelvic floor produces urinary incontinence, cysto and rectocele, genital prolapses and sexual dysfunctions. The above mentioned pathology can be corrected by laparoscopic promontofixation, whatever the previous history of pelvic surgery, including the placing of prosthetic material. In this article we describe the above mentioned intervention. Material and methods Preoperative care is standardized and is accompanied by antibiotic prophylaxis, preventive antithrombotic treatment and in the event of a history of pelvic surgery, a digestive preparation. Positioning of the patient must plan a 30° Trendelenbourg position. After the introduction the trocars, initial surgery comprises anterior dissection of promontory after incision of the posterior peritoneum with the patient placed beforehand in a Trendelembourg position. After that, we make interrectovaginal dissection to free the whole posterior surface of the vagina. This is followed by the installation of a posterior mesh pre-cut in an arc. After intervesical vaginal dissection, the anterior prosthesis comprising a precut polyester mesh is fixed avoiding excess traction. The end of the surgery involves careful reperitonization of all the prosthetic parts. Possible specific surgical complications are vascular and visceral wounds. Results y conclusions The technique allows the correction of the dysfunction of the pelvic floor and incontinence with good anatomical and functional results. Postoperative secondary haemorrhage and gastrointestinal occlusion may ocurr. Occurrence of an inflammatory syndrome and low back pain suggests spondylodicitis and MRI should be performed. Vaginal erosion on the prosthesis may occur after several months and seems relatively independent of the prosthetic material used.

Undifferentiated Spondyloarthritis: A Longterm Followup

To analyze the longterm followup of a series of Brazilian patients with undifferentiated spondyloarthritis (uSpA). Prospective study analyzing a group of 111 patients with the diagnosis of uSpA, fulfilling the European Spondylarthropathy Study Group and the Amor criteria, who were followed for 5 to 10 years in a single university referral center. Patients had their outcome analyzed at 5, 7, and 10 years. There was a predominance of men (81.1%), white ethnicity (78.4%), and positive HLA-B27 (61.3%), with a mean age at onset of 27.2 years. Twenty-seven patients presented development to ankylosing spondylitis (AS; 24.3%) and 3 to psoriatic arthritis (PsA; 2.7%), while 25 patients (22.5%) went into remission during the followup. Univariate logistic regression analysis revealed that ethnicity, HLA-B27, buttock pain, inflammatory low back pain, ankle involvement, grade I sacroiliitis at the beginning of the study, and the use of sulfasalazine were statistically associated with progression to AS. Multivariate logistic regression analysis revealed that HLA-B27 (p = 0.035, OR 6.720, 95% CI 11.45-39.43) and buttock pain (p = 0.009, OR 6.211, 95% CI 1.591-24.25) were statistically associated with progression to AS. In a longterm followup of 111 Brazilian patients with uSpA, HLA-B27 and buttock pain were significant predictors of progression to a definite disease.

Spondyloarthritis in a Patient With Unilateral Buttock Pain and History of Crohn Disease

Patients with inflammatory spinal conditions related to spondyloarthritis are rarely seen by primary care practitioners. However, patients with a history of inflammatory bowel disease and chronic low back or buttock pain should be examined carefully for the presence of spondyloarthritis, as proper management may include referral to a rheumatologist and appropriate medical intervention. A 27-year-old woman with a 6-month history of posterior buttock pain was referred for physical therapy with a diagnosis of piriformis syndrome. During the second physical therapy visit, a nonmechanical source of lumbopelvic pain was suspected, and the patient was referred for medical consultation. The patient underwent evaluation by a rheumatologist and was eventually diagnosed with spondyloarthritis associated with inflammatory bowel disease. The patient initiated treatment with anti-tumor necrosis factor medication to address the spondyloarthritis. Medical management resulted in significant improvement in all outcome measures. Clinical suspicion of spondyloarthritis is raised when specific historical, examination, and imaging findings are present. The posttest probability of spondyloarthritis is increased with the presence of inflammatory back pain and specific spondyloarthritic features, such as a positive history of inflammatory bowel disease, radiographic evidence of sacroiliitis, and improvement with anti-inflammatory medication. Referral of patients with these findings for a rheumatological evaluation is warranted, as these diseases are managed effectively with specific treatment.

Laparoscopic promontofixation. Our technique

ObjectivesThe pathology of the pelvic floor, including urinary incontinence, anal incontinence and genital prolapse, is very dominant, concerning approximately a third of adult women. It is fundamental that this musculature supports a good function, because weakness of the pelvic floor produces urinary incontinence, cysto and rectocele, genital prolapses and sexual dysfunctions. The abovementioned pathology can be corrected by laparoscopic promontofixation, whatever the previous history of pelvic surgery, including the placing of prosthetic material. In this article we describe the abovementioned intervention. Material and methodsPreoperative care is standardized and is accompanied by antibiotic prophylaxis, preventive antithrombotic treatment and in the event of a history of pelvic surgery, a digestive preparation. Positioning of the patient must plan a 30° Trendelenbourg position. After the introduction of the trocars, initial surgery comprises anterior dissection of promontory after incision of the posterior peritoneum with the patient placed beforehand in a Trendelembourg position. After that, we make interrectovaginal dissection to free the whole posterior surface of the vagina. This is followed by the installation of a posterior mesh pre-cut in an arc. After intervesical vaginal dissection, the anterior prosthesis comprising a precut polyester mesh is fixed avoiding excess traction. The end of the surgery involves careful reperitonization of all the prosthetic parts. Possible specific surgical complications are vascular and visceral wounds. Results and conclusionsThe technique allows the correction of the dysfunction of the pelvic floor and incontinence with good anatomical and functional results. Postoperative secondary haemorrhage and gastrointestinal occlusion may occur. Occurrence of an inflammatory syndrome and low back pain suggests spondylodicitis and MRI should be performed. Vaginal erosion on the prosthesis may occur after several months and seems relatively independent of the prosthetic material used.

P61 Incremental clinical benefit (including remission) versus MTX monotherapy in MTX naïve early RA patients who achieve radiographic non-progression

To study the clinical, laboratory and radiographic characteristics of ankylosing spondylitis (AS) patients living in Qatar.Sixty-two consecutive AS patients including 4 Qataris were enrolled. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and AS quality of life (ASQoL) scores were calculated. Inflammatory markers, human leukocytic antigen-B27 (HLA-B27), plain x-rays and magnetic resonance imaging of the sacroiliac joint and spine were considered.Mean age at symptom onset was 25.9 ± 7.3 years and at diagnosis 32.3 ± 8.4 years with an average delay in the diagnosis of 6.4 years. The male-to-female ratio was 5.2:1. Arabs comprised 40.3% while 59.7% were non-Arabs. HLA-B27 was positive in 80.7%. Family history of spondyloarthritis was present in 16 (25.8%) patients. All patients had inflammatory low back pain. Peripheral arthritis was observed in 46.8%, heel enthesitis in 37.1% and tenosynovitis in 14.5% patients. Anterior uveitis occurred in 14.5% patients. Radiological evidence of bilateral sacroiliitis and spine involvement was observed in 83.3% and 59.7% patients respectively. Mean erythrocyte sedimentation rate and C-reactive protein were 20.3 ± 14.2 mm/hr and 11.4 ± 11.8 mg/L respectively. Mean BASDAI, BASFI and ASQoL were 3.3 ± 1.8, 2.9 ± 2.1 and 6.5 ± 5.2 respectively. Twenty-eight patients (45.2%) were maintained on NSAIDs monotherapy, 14.5% were receiving DMARDs and 40.3% were on biologics.The characteristics of AS patients in Qatar are revealed. Similar to others, there is male predominance. Disease activity and functional status were found to be low which may be due to high frequency of patients receiving biologics.

Identification of RGS1 as a candidate biomarker for undifferentiated spondylarthritis by genome‐wide expression profiling and real‐time polymerase chain reaction

To compare gene expression profiles between ankylosing spondylitis (AS) and undifferentiated spondylarthritis (uSpA) patients with inflammatory low back pain. Peripheral blood mononuclear cells (PBMCs) from patients with AS, patients with uSpA, and healthy subjects were screened using genome-wide microarrays, followed by validation by real-time polymerase chain reaction (PCR). Microarray profiling and real-time PCR assays showed only minor differences between AS patients and healthy subjects. In contrast, 20 genes were strikingly more highly expressed in uSpA patients. Regulator of G protein signaling 1 (RGS1) was identified as the most useful biomarker for distinguishing uSpA patients, and to a lesser extent AS patients, from control subjects (P = 2.3 x 10(-7) and 6.7 x 10(-3), respectively). These findings were verified in an independent cohort that also included patients with rheumatoid arthritis and patients with mechanical low back pain. The receiver operating characteristic area under the curve values in the first and second cohorts of uSpA patients were 0.99 and 0.93, respectively (P = 1 x 10(-4)). To evaluate the possible derivation of RGS1, we cultured a monocyte-derived cell line with a panel of cytokines and chemokines. RGS1 was significantly induced either by tumor necrosis factor alpha (TNFalpha) or by interleukin-17 (IL-17). Our findings indicate that uSpA PBMCs carry strikingly more highly expressed genes compared with PBMCs from AS patients or healthy subjects, and that TNFalpha- and IL-17-inducible RGS1 is a potential biomarker for uSpA, and to a lesser extent for AS, with inflammatory low back pain.

Inflammatory low back pain in early diagnosis of spondyloarthritides

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